Healthcare Provider Details

I. General information

NPI: 1346150844
Provider Name (Legal Business Name): KELLY OETTING
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 DURHAM RD
PENNDEL PA
19047-5707
US

IV. Provider business mailing address

2080 CABOT BLVD W
LANGHORNE PA
19047-1813
US

V. Phone/Fax

Practice location:
  • Phone: 267-587-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: