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General NPI Number Information
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NPI Number | 1356674618
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Entity Type | Individual
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Provider Name | SANDRA P. Y. L. THIEBLEMONT M. S. O.T.R./L
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Gender | Female
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 2151 LINGLESTOWN RD
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City | HARRISBURG
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State | PA
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Zip | 17110-9499
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Country | US
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Telephone | 717-540-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 2217 CONTINENTAL DR
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City | HARRISBURG
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State | PA
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Zip | 17110-3465
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Country | US
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Telephone | 717-233-6227
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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 | OC008711
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License Number State | PA
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