Provider Demographics
NPI:1215256219
Name:DE LA PAVA, MARCELA (OTR/L)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:DE LA PAVA
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 1:41 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3951
Mailing Address - Country:US
Mailing Address - Phone:914-403-3248
Mailing Address - Fax:
Practice Address - Street 1:41 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3951
Practice Address - Country:US
Practice Address - Phone:914-403-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024400-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist