Basic Information
Provider Information
NPI: 1003143066
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAUSLEIN
FirstName: KATHLEEN
MiddleName:  
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Credential:  
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Mailing Information
Address1: 400 GLENDALE RD
Address2: UNIT J 13
City: HAVERTOWN
State: PA
PostalCode: 190833152
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2250 HICKORY RD
Address2: SUITE 240
City: PLYMOUTH MEETING
State: PA
PostalCode: 194621047
CountryCode: US
TelephoneNumber: 8008794471
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/12/2009
LastUpdateDate: 11/12/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
224Z00000XOP002363LPAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant 

No ID Information.


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