Provider Demographics
NPI:1396054003
Name:PANZARELLO, MICHELLE DIANE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:PANZARELLO
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 1:873 BOSTWICK RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9310
Mailing Address - Country:US
Mailing Address - Phone:812-431-5875
Mailing Address - Fax:
Practice Address - Street 1:873 BOSTWICK RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9310
Practice Address - Country:US
Practice Address - Phone:812-431-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist