Provider Demographics
NPI:1992503536
Name:IANNUCCI, MARC (OTA)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:IANNUCCI
Suffix:
Gender:
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4017
Mailing Address - Country:US
Mailing Address - Phone:203-979-9440
Mailing Address - Fax:866-232-5535
Practice Address - Street 1:56 PARTRIDGE DR
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4017
Practice Address - Country:US
Practice Address - Phone:203-979-9440
Practice Address - Fax:866-232-5535
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000878224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant