Provider Demographics
NPI:1780341990
Name:PETSCHAUER, ALLYSON MARGARET
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MARGARET
Last Name:PETSCHAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:MARGARET
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 LAUREL HILL EST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1190
Mailing Address - Country:US
Mailing Address - Phone:570-390-9140
Mailing Address - Fax:
Practice Address - Street 1:23 ELLEN MEMORIAL LN
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-4096
Practice Address - Country:US
Practice Address - Phone:570-253-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist