Healthcare Provider Details

I. General information

NPI: 1205372703
Provider Name (Legal Business Name): CASEY MCCONAHY MOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 PENN ST SUITE 103
HOLLIDAYSBURG PA
16648-2044
US

IV. Provider business mailing address

620 HOWARD AVE
ALTOONA PA
16601-4804
US

V. Phone/Fax

Practice location:
  • Phone: 814-695-2923
  • Fax: 814-695-2924
Mailing address:
  • Phone: 814-889-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC014306
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: