MEDICARE: CARLIE MADELLE KLANICA OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC017512	PA

General Provider Information

NPI Number	:	1407440340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLIE MADELLE KLANICA OTR

Provider Business Mailing Address
First Line	:	2757 LEECHBURG RD
Second Line	:
City	:	LOWER BURRELL
State	:	PA
Zip	:	15068-3138
Country	:	US
Telephone Number	:	724-337-6522
Fax Number	:	724-337-0630

Provider Business Practice Location Address
First Line	:	1316 PITTSBURGH ST
Second Line	:
City	:	CHESWICK
State	:	PA
Zip	:	15024-1447
Country	:	US
Telephone Number	:	724-274-4333
Fax Number	:	724-274-4303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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