Provider Demographics
NPI:1194911131
Name:PURVIS, SANDRA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:PURVIS
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 1:63 W LANCASTER AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1413
Mailing Address - Country:US
Mailing Address - Phone:610-649-1400
Mailing Address - Fax:610-649-1715
Practice Address - Street 1:63 W LANCASTER AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1413
Practice Address - Country:US
Practice Address - Phone:610-649-1400
Practice Address - Fax:610-649-1715
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004044L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist