Healthcare Provider Details

I. General information

NPI: 1851872972
Provider Name (Legal Business Name): MIRANDA ANN MORAVETZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 PROSPERITY DR STE 210
SILVER SPRING MD
20904-1684
US

IV. Provider business mailing address

12520 PROSPERITY DR STE 210
SILVER SPRING MD
20904-1684
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-7505
  • Fax: 301-869-7515
Mailing address:
  • Phone: 301-869-7505
  • Fax: 301-869-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number08560
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: