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General NPI Number Information
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NPI Number | 1245658061
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Entity Type | Individual
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Provider Name | HUNTER KORCHAK
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Gender | Male
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 03/29/2014
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Provider Practice Location Address
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Address Line | 90 HUMBERT LN
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City | WASHINGTON
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State | PA
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Zip | 15301-6549
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Country | US
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Telephone | 724-228-5666
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 AJAY DR
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City | SOUTH PARK
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State | PA
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Zip | 15129-9560
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Country | US
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Telephone |
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Fax |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC12576
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License Number State | PA
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