Healthcare Provider Details

I. General information

NPI: 1316995947
Provider Name (Legal Business Name): ERICA KOPCHA MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 FRANKFORD AVE
PHILADELPHIA PA
19136-2786
US

IV. Provider business mailing address

2 W 10TH ST
MARCUS HOOK PA
19061-4513
US

V. Phone/Fax

Practice location:
  • Phone: 215-338-8900
  • Fax: 215-338-8923
Mailing address:
  • Phone: 610-859-8850
  • Fax: 610-859-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC-009140
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberU1-0001110
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: