Basic Information
Provider Information
NPI: 1326478967
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RICCADONNA
FirstName: JULIANNE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 212 TYLER DR
Address2:  
City: CRANBERRY TWP
State: PA
PostalCode: 160663218
CountryCode: US
TelephoneNumber: 7247745422
FaxNumber:  
Practice Location
Address1: 257 GEORGETOWN RD
Address2:  
City: BEAVER FALLS
State: PA
PostalCode: 150109740
CountryCode: US
TelephoneNumber: 7248468200
FaxNumber: 7248472998
Other Information
ProviderEnumerationDate: 11/18/2013
LastUpdateDate: 11/19/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOC001808LPAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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