Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC001086L | PA |
NPI | 1700116027 |
---|---|
Provider Name | Mrs. Teresa Lynn Rothenberger |
First Address | Wernersville, PA 19565-1642 |
Second Address | Wernersville, PA 19565-1642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2010 |
Last Update Date | 08/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OC001086L | STATE LICENSE (01) | PA |