Provider Demographics
NPI:1912234931
Name:INGRAHAM, MAUREEN NOVLET (OT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:NOVLET
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:NOVLET
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:80 N CLARKE RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-9163
Practice Address - Country:US
Practice Address - Phone:407-299-2710
Practice Address - Fax:407-299-2185
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist