Provider Demographics
NPI:1881723195
Name:VITELLI, LISA RICHARDS (OTRL)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RICHARDS
Last Name:VITELLI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 KRIEBEL MILL RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1525
Mailing Address - Country:US
Mailing Address - Phone:610-584-1155
Mailing Address - Fax:610-584-1155
Practice Address - Street 1:1314 KRIEBEL MILL RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-1525
Practice Address - Country:US
Practice Address - Phone:610-584-1155
Practice Address - Fax:610-584-1155
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001511L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics