Healthcare Provider Details

I. General information

NPI: 1457753477
Provider Name (Legal Business Name): KATIE HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

IV. Provider business mailing address

2707 HENDERSON RD
WHITE OAK PA
15131-1826
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-6400
  • Fax:
Mailing address:
  • Phone: 412-251-2952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP007903
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: