Provider Demographics
NPI:1740904614
Name:PACHECO, MIKAELA (MSOT)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 SUSAN AVE
Mailing Address - Street 2:
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-5554
Mailing Address - Country:US
Mailing Address - Phone:267-798-9548
Mailing Address - Fax:
Practice Address - Street 1:1408 SUSAN AVE
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-5554
Practice Address - Country:US
Practice Address - Phone:267-798-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist