Provider Demographics
NPI:1871731018
Name:MLA MANAGEMENT, INC.
Entity type:Organization
Organization Name:MLA MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:570-778-4742
Mailing Address - Street 1:75 YELLOW RUN RD
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2704
Mailing Address - Country:US
Mailing Address - Phone:570-778-4742
Mailing Address - Fax:570-325-8687
Practice Address - Street 1:75 YELLOW RUN RD
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229-2704
Practice Address - Country:US
Practice Address - Phone:570-778-4742
Practice Address - Fax:570-325-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006982L225X00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty