Provider Demographics
NPI:1063399939
Name:TAVERAS, WILMA MARIC (OTR/L)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:MARIC
Last Name:TAVERAS
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 1:3126 ALTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6902
Mailing Address - Country:US
Mailing Address - Phone:484-597-9451
Mailing Address - Fax:
Practice Address - Street 1:3126 ALTON AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6902
Practice Address - Country:US
Practice Address - Phone:484-597-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist