Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC013536 | PA |
NPI | 1801298641 |
---|---|
Provider Name | Amanda Kline |
First Address | Lansdale, PA 19446-4760 |
Second Address | Elkins Park, PA 19027-2221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 24/09/2014 |