Provider Demographics
NPI:1487935318
Name:ROMANELLI, MAURA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:
Last Name:ROMANELLI
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:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:MAINE
Mailing Address - State:NY
Mailing Address - Zip Code:13802-0218
Mailing Address - Country:US
Mailing Address - Phone:607-862-3263
Mailing Address - Fax:
Practice Address - Street 1:2693 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAINE
Practice Address - State:NY
Practice Address - Zip Code:13802
Practice Address - Country:US
Practice Address - Phone:607-862-3263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012382-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist