Provider Demographics
NPI:1679881452
Name:SPAVENTA DEISHER, MIRELLA (MS, OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:MIRELLA
Middle Name:
Last Name:SPAVENTA DEISHER
Suffix:
Gender:F
Credentials:MS, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-9540
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:
Practice Address - Street 1:4136 W TILGHMAN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4428
Practice Address - Country:US
Practice Address - Phone:610-530-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006067L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist