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General NPI Number Information
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NPI Number | 1710460761
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Entity Type | Individual
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Provider Name | JENNIFER MARICELLI HHP,RMA
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Gender | Female
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 1620 REGENT ST STE B
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City | MISSOULA
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State | MT
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Zip | 59801-5685
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Country | US
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Telephone | 406-370-0425
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Fax |
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Provider Business Mailing Address
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Address Line | 19820 RAMBLING ROSE LN
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City | FLORENCE
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State | MT
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Zip | 59833-6089
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Country | US
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Telephone | 406-370-0425
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 53373505
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 53373505
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 53373505
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License Number State | TX
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