Provider Demographics
NPI:1295007615
Name:SPADAVECCHIA, N (OTR/L)
Entity Type:Individual
Prefix:
First Name:N
Middle Name:
Last Name:SPADAVECCHIA
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:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-0865
Mailing Address - Country:US
Mailing Address - Phone:301-904-5720
Mailing Address - Fax:
Practice Address - Street 1:45297 MILL COVE HARBOR RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-3591
Practice Address - Country:US
Practice Address - Phone:301-904-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist