Basic Information
| Provider Information | |||||||||
| NPI: | 1316995947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOPCHA | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 8019 FRANKFORD AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191362786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153388900 | ||||||||
| FaxNumber: | 2153388923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 10/13/2010 | ||||||||
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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 | 225X00000X | OC-009140 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | U1-0001110 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 306169 | 01 | UNISON | OTHER | 1316995947 | 01 | PA | BRAVO | OTHER | 1749958 | 01 | PA | HIGHMARK PA BLUE SHIELD | OTHER | 30056540 | 01 | PA | KEYSTONE MERCY | OTHER | 1316995947 | 01 | DELAWARE PHYSICIANS CARE | OTHER | 2415419000 | 01 | IBC PERSONAL CHOICE | OTHER | 1023730790001 | 05 | PA | MEDICAID | P00713323 | 01 | PA | MEDICARE RR | OTHER |