Provider Demographics
NPI:1851872972
Name:MORAVETZ, MIRANDA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ANN
Last Name:MORAVETZ
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 1:12520 PROSPERITY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1684
Mailing Address - Country:US
Mailing Address - Phone:301-869-7505
Mailing Address - Fax:301-869-7515
Practice Address - Street 1:12520 PROSPERITY DR STE 210
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1684
Practice Address - Country:US
Practice Address - Phone:301-869-7505
Practice Address - Fax:301-869-7515
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08560225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics