MEDICARE: MARISA SAKELLARIOU OTL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1508602426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA SAKELLARIOU OTL

Provider Business Mailing Address
First Line	:	709 SAN MARINO CT
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9683
Country	:	US
Telephone Number	:	415-272-6580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 TOWN CENTER WEST WAY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-7575
Country	:	US
Telephone Number	:	916-975-9866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	07/02/2024

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