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General NPI Number Information
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NPI Number | 1235342171
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Entity Type | Individual
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Provider Name | DALE B ELLENBERG MS OTRL
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 7308 BRYAN ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1634
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Country | US
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Telephone | 215-284-4256
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Fax |
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Provider Business Mailing Address
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Address Line | 7308 BRYAN ST 1ST FL
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1634
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Country | US
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Telephone | 215-284-4256
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Fax | 267-297-7527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC001722L
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License Number State | PA
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