Basic Information
Provider Information | |||||||||
NPI: | 1144666538 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CICHANOWSKY | ||||||||
FirstName: | KIMBERLY | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | OT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOULDIN | ||||||||
OtherFirstName: | KIMBERLY | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | OT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3809 WEST CHESTER PIKE | ||||||||
Address2: | STE 150 | ||||||||
City: | NEWTOWN SQUARE | ||||||||
State: | PA | ||||||||
PostalCode: | 190730259 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6103595640 | ||||||||
FaxNumber: | 6103591519 | ||||||||
Practice Location | |||||||||
Address1: | 400 MCFARLAN RD | ||||||||
Address2: |   | ||||||||
City: | KENNETT SQUARE | ||||||||
State: | PA | ||||||||
PostalCode: | 193482477 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109254901 | ||||||||
FaxNumber: | 6109254906 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/13/2013 | ||||||||
LastUpdateDate: | 08/27/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC003022L | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
No ID Information.