Provider Demographics
NPI:1053563858
Name:GUASTAFERRO, VIRGINIA L (OTR/L)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:GUASTAFERRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 MACBETH DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3332
Mailing Address - Country:US
Mailing Address - Phone:412-856-7071
Mailing Address - Fax:412-856-7370
Practice Address - Street 1:885 MACBETH DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3332
Practice Address - Country:US
Practice Address - Phone:412-856-7071
Practice Address - Fax:412-856-7370
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002913L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist