Provider Demographics
NPI:1356573224
Name:SPELLMAN, MARY BETH BRIDGET (OTR/L)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:BRIDGET
Last Name:SPELLMAN
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 1:131 BARBER ST
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-2027
Mailing Address - Country:US
Mailing Address - Phone:570-826-3832
Mailing Address - Fax:
Practice Address - Street 1:53 GRAVEL ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18705-3738
Practice Address - Country:US
Practice Address - Phone:570-371-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001613L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics