Provider Demographics
NPI:1386117158
Name:PAGLICCIA, MARISA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:PAGLICCIA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:CAPOGRECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 WALKER MDW
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05250-8502
Mailing Address - Country:US
Mailing Address - Phone:330-883-6346
Mailing Address - Fax:
Practice Address - Street 1:40 WALKER MDW
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05250-8502
Practice Address - Country:US
Practice Address - Phone:330-883-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6711031Medicaid