Provider Demographics
NPI:1861614414
Name:VIRONE, MIRANDA (OTR/L)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:VIRONE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:258 MESA DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16229-2414
Mailing Address - Country:US
Mailing Address - Phone:724-212-3295
Mailing Address - Fax:
Practice Address - Street 1:2757 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3138
Practice Address - Country:US
Practice Address - Phone:724-337-6522
Practice Address - Fax:724-337-0630
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.6335225X00000X
PAOC008545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist