Provider Demographics
NPI:1154634608
Name:CROVETTI, TISHA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:CROVETTI
Suffix:
Gender:F
Credentials:MS, 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:BOX 298
Mailing Address - Street 2:4128 SURREY LANE
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474
Mailing Address - Country:US
Mailing Address - Phone:484-686-8436
Mailing Address - Fax:
Practice Address - Street 1:461 CANN RD
Practice Address - Street 2:QUEST THERAPEUTIC SERVICES, INC
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382
Practice Address - Country:US
Practice Address - Phone:610-692-6362
Practice Address - Fax:610-692-0917
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist