MEDICARE: MARACHEL CO

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	OT12743	FL

General Provider Information

NPI Number	:	1821417734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARACHEL CO

Provider Business Mailing Address
First Line	:	525 76TH AVE
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706-1805
Country	:	US
Telephone Number	:	813-335-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 76TH AVE
Second Line	:
City	:	ST PETE BEACH
State	:	FL
Zip	:	33706-1805
Country	:	US
Telephone Number	:	813-335-8001
Fax Number	:

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

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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Directions to “ MARACHEL CO ” Practice Location

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