MEDICARE: KELLY KLINGER OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC002339	PA

General Provider Information

NPI Number	:	1043224405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY KLINGER OT

Provider Business Mailing Address
First Line	:	283 MOUNTAIN ROAD
Second Line	:
City	:	BERWICK
State	:	PA
Zip	:	18603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 GLENN AVE
Second Line	:	SUITE 101
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-1200
Country	:	US
Telephone Number	:	570-387-2135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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