Provider Demographics
NPI:1548420862
Name:SPAVENTA, JUDITH A (MOT,OTR/L)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:SPAVENTA
Suffix:
Gender:F
Credentials:MOT,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LOCOMOTIVE LN
Mailing Address - Street 2:UNIT 202
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8522
Mailing Address - Country:US
Mailing Address - Phone:828-446-9463
Mailing Address - Fax:
Practice Address - Street 1:106 LOCOMOTIVE LN
Practice Address - Street 2:UNIT 202
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-8522
Practice Address - Country:US
Practice Address - Phone:828-446-9463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6866225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302089Medicaid
NC1548420862OtherBCBS