Provider Demographics
NPI:1790273530
Name:UNDERWOOD, DEVON
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 BAMBERGER RD
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9730
Mailing Address - Country:US
Mailing Address - Phone:717-602-3634
Mailing Address - Fax:
Practice Address - Street 1:671 BAMBERGER RD
Practice Address - Street 2:
Practice Address - City:ETTERS
Practice Address - State:PA
Practice Address - Zip Code:17319-9730
Practice Address - Country:US
Practice Address - Phone:717-602-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist