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General NPI Number Information
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NPI Number | 1437883956
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Entity Type | Individual
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Provider Name | MARISA NOEMI PELLEGRINI
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Gender | Female
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 7100 W COLLEGE DR
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1566
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Country | US
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Telephone | 919-825-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 15239 CREEKSIDE DR APT C
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City | OAK FOREST
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State | IL
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Zip | 60452-2362
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Country | US
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Telephone | 708-559-9368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 057.004749
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License Number State | IL
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