Provider Demographics
NPI:1598597528
Name:MILAVETZ, MARISA LUCILLE (OTD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:LUCILLE
Last Name:MILAVETZ
Suffix:
Gender:F
Credentials:OTD
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Other - First Name:
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Mailing Address - Street 1:19 VALLEY VIEW KNL NE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-9138
Mailing Address - Country:US
Mailing Address - Phone:319-631-9573
Mailing Address - Fax:
Practice Address - Street 1:2631 GATTIS SCHOOL RD STE 160
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2825
Practice Address - Country:US
Practice Address - Phone:512-233-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX124870225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics