Provider Demographics
NPI:1194077966
Name:MUSCARELLO, NELLIE ALEXANDRA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:ALEXANDRA
Last Name:MUSCARELLO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:NELLIE
Other - Middle Name:ALEXANDRA
Other - Last Name:FAUVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:8754 S 280 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1606
Mailing Address - Country:US
Mailing Address - Phone:801-560-5504
Mailing Address - Fax:
Practice Address - Street 1:90 ALBION VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4013
Practice Address - Country:US
Practice Address - Phone:801-619-3670
Practice Address - Fax:801-619-3679
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009896225X00000X
UT9583984-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist