Provider Demographics
NPI:1720313323
Name:SPINELLI, SARA COLETTE (OT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:COLETTE
Last Name:SPINELLI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1418
Mailing Address - Country:US
Mailing Address - Phone:570-785-2018
Mailing Address - Fax:570-785-3575
Practice Address - Street 1:354 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:PA
Practice Address - Zip Code:18421-1418
Practice Address - Country:US
Practice Address - Phone:570-785-2018
Practice Address - Fax:570-785-3575
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011198225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023823270001Medicaid
PA166562Medicare UPIN