Provider Demographics
NPI:1194092825
Name:SPISIC, LARYSA OLENKA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:LARYSA
Middle Name:OLENKA
Last Name:SPISIC
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:LARYSA
Other - Middle Name:OLENKA
Other - Last Name:HALAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1226 FAIRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2924
Mailing Address - Country:US
Mailing Address - Phone:215-887-0284
Mailing Address - Fax:
Practice Address - Street 1:1226 FAIRY HILL RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2924
Practice Address - Country:US
Practice Address - Phone:215-887-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008546225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics