Basic Information
| Provider Information | |||||||||
| NPI: | 1992821441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANISLAW | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | JOANNE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | OTA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BEROSH | ||||||||
| OtherFirstName: | KATHY | ||||||||
| OtherMiddleName: | JOANNE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 21 S HELLERTOWN AVE APT 2 | ||||||||
| Address2: | |||||||||
| City: | QUAKERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189511771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107377481 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3485 DAVISVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HATBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190404220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158300400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OP002941L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.