1790853364 NPI number — MS. THERESE M SKIRVEN OT

Table of content: MS. THERESE M SKIRVEN OT (NPI 1790853364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790853364 NPI number — MS. THERESE M SKIRVEN OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKIRVEN
Provider First Name:
THERESE
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SKIRVEN-DIGIORGIO
Provider Other First Name:
THERESE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790853364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5228
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19380-0405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-359-5672
Provider Business Mailing Address Fax Number:
610-768-5947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
834 CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE G114
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-521-3000
Provider Business Practice Location Address Fax Number:
215-521-3002
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  OC000553L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OC000553L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1452888 . This is a "IBC - PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2138758000 . This is a "IBC - KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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