Provider Demographics
NPI:1861555104
Name:PASCUAL, MARIELLE (OTRL)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 S SHENANDOAH ST # 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4427
Mailing Address - Country:US
Mailing Address - Phone:818-422-3170
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1559
Practice Address - Country:US
Practice Address - Phone:818-763-0136
Practice Address - Fax:818-763-3838
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7514225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT7514AMedicare PIN