Provider Demographics
NPI:1194854158
Name:LOVINGER, MITCHEL (OT)
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:
Last Name:LOVINGER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1712
Mailing Address - Country:US
Mailing Address - Phone:540-908-8938
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:302 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1712
Practice Address - Country:US
Practice Address - Phone:540-908-8938
Practice Address - Fax:610-438-2046
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000924225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496665Medicare Oscar/Certification