Provider Demographics
NPI:1194431775
Name:BISCOCHO, MAREDYL (OTR/L)
Entity type:Individual
Prefix:
First Name:MAREDYL
Middle Name:
Last Name:BISCOCHO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 WILLOWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9725
Mailing Address - Country:US
Mailing Address - Phone:646-895-4501
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTREVILLE RD STE 400
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8411
Practice Address - Country:US
Practice Address - Phone:571-377-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009741225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist