Provider Demographics
NPI:1235478371
Name:SPIVACK, JOANNA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:SPIVACK
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 1:6 STUYVESANT OVAL
Mailing Address - Street 2:APT. 4C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2412
Mailing Address - Country:US
Mailing Address - Phone:914-907-4272
Mailing Address - Fax:
Practice Address - Street 1:6 STUYVESANT OVAL
Practice Address - Street 2:APT. 4C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2412
Practice Address - Country:US
Practice Address - Phone:914-907-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015422-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist