Provider Demographics
NPI:1760588610
Name:DESALVO, RICK A (OT)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:A
Last Name:DESALVO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:520 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3902
Mailing Address - Country:US
Mailing Address - Phone:724-463-7478
Mailing Address - Fax:724-463-0931
Practice Address - Street 1:184 DONALD LN
Practice Address - Street 2:SUITE 10
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2835
Practice Address - Country:US
Practice Address - Phone:814-266-1974
Practice Address - Fax:814-266-3407
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003435L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA261177OtherHEALTH AMER/HEALTH ASSUR.
PA1699158OtherHIGHMARK BLUE SHIELD
PA261177OtherHEALTH AMER/HEALTH ASSUR.