MEDICARE: MICHAELA YENNELLA

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	0119011237	VA
2	225X00000X	Occupational Therapist	46TR01115800	NJ

General Provider Information

NPI Number	:	1881396117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA YENNELLA

Provider Business Mailing Address
First Line	:	82 BETHANY RD STE 1
Second Line	:
City	:	HAZLET
State	:	NJ
Zip	:	07730-1459
Country	:	US
Telephone Number	:	732-888-3912
Fax Number	:

Provider Business Practice Location Address
First Line	:	7051 HEATHCOTE VILLAGE WAY STE 105
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3197
Country	:	US
Telephone Number	:	703-291-1254
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	02/18/2026

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