Basic Information
| Provider Information | |||||||||
| NPI: | 1124438817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EHRLICH | ||||||||
| FirstName: | MITCHELL | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1023 E BALTIMORE PIKE | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190635126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108911636 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1023 E BALTIMORE PIKE | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190635126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108911636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2014 | ||||||||
| LastUpdateDate: | 05/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC006291L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.