MEDICARE: KELSEY GRYCKIEWICZ

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	OC019773	PA

General Provider Information

NPI Number	:	1952269805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY GRYCKIEWICZ

Provider Business Mailing Address
First Line	:	158 MAPLE AVE
Second Line	:
City	:	LAKE ARIEL
State	:	PA
Zip	:	18436-4207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 MAPLE AVE
Second Line	:
City	:	LAKE ARIEL
State	:	PA
Zip	:	18436-4207
Country	:	US
Telephone Number	:	856-693-1531
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 “ KELSEY GRYCKIEWICZ ” Practice Location

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