Basic Information
| Provider Information | |||||||||
| NPI: | 1205834298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANLEER | ||||||||
| FirstName: | POLLENE | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 PHILADELPHIA ST | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244637478 | ||||||||
| FaxNumber: | 7244630931 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194603810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109351120 | ||||||||
| FaxNumber: | 6109355507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 02/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 164224 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 256072 | 01 | PA | HEALTH AMERICA-ASSURANCE | OTHER | 0164718000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER |