Healthcare Provider Details

I. General information

NPI: 1629931555
Provider Name (Legal Business Name): JONATHAN R EDLEMAN OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W LINFIELD TRAPPE RD
LIMERICK PA
19468-1807
US

IV. Provider business mailing address

560 N ROUTE 100
BECHTELSVILLE PA
19505-9228
US

V. Phone/Fax

Practice location:
  • Phone: 484-948-2800
  • Fax: 610-792-3044
Mailing address:
  • Phone: 484-948-2800
  • Fax: 610-792-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC005146L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: