MEDICARE: MYLEA NEIDIG

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

General Provider Information

NPI Number	:	1295693901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLEA NEIDIG

Provider Business Mailing Address
First Line	:	64 RIDGWAY DR
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612-9263
Country	:	US
Telephone Number	:	570-608-8923
Fax Number	:	570-255-4575

Provider Business Practice Location Address
First Line	:	2725 FOUR MILE DR
Second Line	:
City	:	MONTOURSVILLE
State	:	PA
Zip	:	17754-9573
Country	:	US
Telephone Number	:	570-608-8923
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ MYLEA NEIDIG ” Practice Location

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