Provider Demographics
NPI:1932619277
Name:MIRANDA-CAPELLA, IVETTEDARI (OTR/L)
Entity type:Individual
Prefix:
First Name:IVETTEDARI
Middle Name:
Last Name:MIRANDA-CAPELLA
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 1:461 PAVONIA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1309
Mailing Address - Country:US
Mailing Address - Phone:787-235-9592
Mailing Address - Fax:
Practice Address - Street 1:549 AUDUBON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3401
Practice Address - Country:US
Practice Address - Phone:646-254-6451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-30
Last Update Date:2017-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020358-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist