Provider Demographics
NPI:1851127906
Name:MORALES, MIRANDA L (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:MORALES
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SHOMONT DR
Mailing Address - Street 2:
Mailing Address - City:HARBORCREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16421-1228
Mailing Address - Country:US
Mailing Address - Phone:814-602-0436
Mailing Address - Fax:814-520-5352
Practice Address - Street 1:275 SHOMONT DR
Practice Address - Street 2:
Practice Address - City:HARBORCREEK
Practice Address - State:PA
Practice Address - Zip Code:16421-1228
Practice Address - Country:US
Practice Address - Phone:814-602-0436
Practice Address - Fax:814-520-5352
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC020051225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics