Basic Information
| Provider Information | |||||||||
| NPI: | 1154634608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROVETTI | ||||||||
| FirstName: | TISHA | ||||||||
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| Credential: | MS, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | BOX 298 | ||||||||
| Address2: | 4128 SURREY LANE | ||||||||
| City: | SKIPPACK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846868436 | ||||||||
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| Practice Location | |||||||||
| Address1: | 461 CANN RD | ||||||||
| Address2: | QUEST THERAPEUTIC SERVICES, INC | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106926362 | ||||||||
| FaxNumber: | 6106920917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2010 | ||||||||
| LastUpdateDate: | 07/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC008356 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.