=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306624952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROADWAY TO INDEPENDENCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2023
-----------------------------------------------------
Last Update Date | 09/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2972 BELLVIEW RD
-----------------------------------------------------
City | SCHNECKSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18078-2881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-216-2933
-----------------------------------------------------
Fax | 855-731-1378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2972 BELLVIEW RD
-----------------------------------------------------
City | SCHNECKSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18078-2881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-216-2933
-----------------------------------------------------
Fax | 855-731-1378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ANGELA M BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-216-2933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224ZR0403X
-----------------------------------------------------
Taxonomy Name | Driving and Community Mobility Occupational Therapy Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------