Basic Information
| Provider Information | |||||||||
| NPI: | 1073024956 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | QUANDT-MCCULLAGH | ||||||||
| FirstName: | AMERIC | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 COLDSPRINGS RD | ||||||||
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| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194657141 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 390 WATERLOO BLVD | ||||||||
| Address2: | |||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848750200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2017 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC007343L | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 39Q7643005 | 05 | PA | MEDICAID |