Provider Demographics
NPI:1790896546
Name:RICCHIUTO, JOANNA M (OTR)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:RICCHIUTO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MEADOWVALE DR
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-9403
Mailing Address - Country:US
Mailing Address - Phone:412-828-0116
Mailing Address - Fax:412-828-0116
Practice Address - Street 1:4125 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1847
Practice Address - Country:US
Practice Address - Phone:724-387-1007
Practice Address - Fax:724-387-1009
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist