Healthcare Provider Details

I. General information

NPI: 1386364669
Provider Name (Legal Business Name): ADRIENNE CAPULONG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MANHEIM PIKE
LANCASTER PA
17601-3120
US

IV. Provider business mailing address

1160 MANHEIM PIKE
LANCASTER PA
17601-3120
US

V. Phone/Fax

Practice location:
  • Phone: 725-206-7929
  • Fax:
Mailing address:
  • Phone: 725-206-7929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC017095
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: