Basic Information
| Provider Information | |||||||||
| NPI: | 1417306283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANGIERI SNURKOWSKI | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | OTR/L | ||||||||
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| OtherLastName: | SNURKOWSKI | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1693 COUNTY HIGHWAY 10 | ||||||||
| Address2: | |||||||||
| City: | LAURENS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704412501 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 BERWICK RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706835036 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2016 | ||||||||
| LastUpdateDate: | 07/02/2018 | ||||||||
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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 | OC003497L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.