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General NPI Number Information
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NPI Number | 1669066619
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Entity Type | Organization
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Legal Business Name | KEYSTONE THERAPY AND TRAUMA SERVICES
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Dates
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Enumeration Date | 02/21/2021
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Last Update Date | 02/21/2021
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Provider Practice Location Address
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Address Line | 1224 S QUEEN ST STE 206
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City | YORK
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State | PA
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Zip | 17403-3961
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Country | US
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Telephone | 410-440-9953
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Fax |
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Provider Business Mailing Address
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Address Line | 3428 SONOMA LN
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City | YORK
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State | PA
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Zip | 17404-8619
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Country | US
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Telephone | 410-440-9953
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALYSSA C OTT
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Credential | LCSW
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Telephone | 410-440-9953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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