Provider Demographics
NPI:1174897136
Name:SPILLANE, JOHN (OTR)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SPILLANE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1732
Mailing Address - Country:US
Mailing Address - Phone:302-422-1600
Mailing Address - Fax:302-684-8931
Practice Address - Street 1:906 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1732
Practice Address - Country:US
Practice Address - Phone:302-684-4950
Practice Address - Fax:302-684-8931
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001003225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist