Marcelle Horn-Mandiola, OTR

Key facts

NPI

1154522704

Entity type

Individual (NPI type 1)

Primary specialty

Pediatric Occupational Therapist 225XP0200X

License

4403 (FL)

Practice address

309 Fox Squirrel LN
Longwood, FL 32779-4904

Phone

(407) 364-9070

Fax

(305) 359-9261

NPI assigned

May 30, 2007

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childhood Coach,LLC Pediatric Occupational Therapist · Longwood, FL · NPI 1396398830
  NPD Authorized official PEDIATRICS

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 24, 2020.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1154522704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 FOX SQUIRREL LN",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327794904",
            "telephone_number": "407-364-9070",
            "fax_number": "305-359-9261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 FOX SQUIRREL LN",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327794904",
            "telephone_number": "407-364-9070",
            "fax_number": "305-359-9261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORN-MANDIOLA",
        "first_name": "MARCELLE",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "FL",
            "license": "4403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004591600",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004591601",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Longwood, FL · Pediatric Occupational Therapist in Florida