Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 04495 | MD |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OC008778 | PA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC008778 | PA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OC008778 | PA |
NPI | 1669570883 |
---|---|
Provider Name | Mr. Joel Hartlan Desotelle |
First Address | Chambersburg, PA 17201-1033 |
Second Address | Scotland, PA 17254-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 11/09/2017 |