Healthcare Provider Details

I. General information

NPI: 1275444549
Provider Name (Legal Business Name): MARY KATE FARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 WHITESTONE COR
STROUDSBURG PA
18360-7193
US

IV. Provider business mailing address

121 RIVER ST
JESSUP PA
18434-1213
US

V. Phone/Fax

Practice location:
  • Phone: 570-476-1600
  • Fax:
Mailing address:
  • Phone: 570-677-3708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC021719
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: