Provider Demographics
NPI:1518138247
Name:LUDEWIG, PETRA JILLIAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:JILLIAN
Last Name:LUDEWIG
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 1:711 NAYLORS RUN RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4523
Mailing Address - Country:US
Mailing Address - Phone:610-853-1873
Mailing Address - Fax:
Practice Address - Street 1:311 E BALTIMORE PIKE
Practice Address - Street 2:SUITE 100A
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3507
Practice Address - Country:US
Practice Address - Phone:610-892-8767
Practice Address - Fax:610-892-8766
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005704L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist