Healthcare Provider Details

I. General information

NPI: 1760016257
Provider Name (Legal Business Name): KOREN KUZMICK OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E LANCASTER AVE
PAOLI PA
19301-1534
US

IV. Provider business mailing address

1450 E LANCASTER AVE
PAOLI PA
19301-1534
US

V. Phone/Fax

Practice location:
  • Phone: 610-859-0002
  • Fax: 800-509-6008
Mailing address:
  • Phone: 570-504-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC015595
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: