Provider Demographics
NPI:1285407890
Name:DESTEFANO, EMILY N (OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:N
Last Name:DESTEFANO
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 1:1075 REDOAK DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1600
Mailing Address - Country:US
Mailing Address - Phone:412-736-1555
Mailing Address - Fax:
Practice Address - Street 1:1075 REDOAK DR
Practice Address - Street 2:
Practice Address - City:HARRISON CITY
Practice Address - State:PA
Practice Address - Zip Code:15636-1600
Practice Address - Country:US
Practice Address - Phone:412-736-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist