Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC11627 | PA |
NPI | 1366087611 |
---|---|
Provider Name | Mrs. Kelly A Eberly |
First Address | Wernersville, PA 19565-9412 |
Second Address | Wernersville, PA 19565-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2019 |
Last Update Date | 11/11/2019 |