Provider Demographics
NPI:1154525947
Name:PETRASIC, CLAIRE NOELLE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:NOELLE
Last Name:PETRASIC
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-3831
Mailing Address - Country:US
Mailing Address - Phone:717-832-1064
Mailing Address - Fax:
Practice Address - Street 1:2 BENEDICT PL STE 1B
Practice Address - Street 2:CORNWALL MANOR
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5358
Practice Address - Country:US
Practice Address - Phone:203-552-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004334L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist