Provider Demographics
NPI:1114400710
Name:PAGAN, NEVIN DAVID (OTR/L)
Entity Type:Individual
Prefix:
First Name:NEVIN
Middle Name:DAVID
Last Name:PAGAN
Suffix:
Gender:M
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 1:2587 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1260
Mailing Address - Country:US
Mailing Address - Phone:717-875-5317
Mailing Address - Fax:
Practice Address - Street 1:867 YORK RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7501
Practice Address - Country:US
Practice Address - Phone:717-337-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist