Healthcare Provider Details

I. General information

NPI: 1770177974
Provider Name (Legal Business Name): EMILIA LIEVANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2021
Last Update Date: 02/27/2021
Certification Date: 02/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W SPROUL RD
SPRINGFIELD PA
19064-2027
US

IV. Provider business mailing address

190 W SPROUL RD
SPRINGFIELD PA
19064-2097
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-8828
  • Fax: 610-338-2717
Mailing address:
  • Phone: 610-328-8828
  • Fax: 610-338-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010187
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: