Provider Demographics
NPI:1063496891
Name:MINEHAN, JOYCE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:MINEHAN
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 1:219 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-4431
Mailing Address - Country:US
Mailing Address - Phone:570-668-1889
Mailing Address - Fax:570-668-6115
Practice Address - Street 1:219 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-4431
Practice Address - Country:US
Practice Address - Phone:570-668-1889
Practice Address - Fax:570-668-6115
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002025L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2996242OtherAETNA HMO
7750414OtherAETNA PPO
1441416OtherHIGHMARK BLUE SHIELD
50004070OtherCAPITAL BLUE CROSS
11228506OtherCAQH
1441416OtherKEYSTONE HEALTH PLAN
815893OtherFIRST PRIORITY HEALTH
1441416OtherKEYSTONE HEALTH PLAN
50004070OtherCAPITAL BLUE CROSS