Basic Information
| Provider Information | |||||||||
| NPI: | 1629390695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOWALCZYK | ||||||||
| FirstName: | MOIRA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | OT/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 131 | ||||||||
| Address2: | |||||||||
| City: | LAHASKA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088944854 | ||||||||
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| Practice Location | |||||||||
| Address1: | 551 WEST LANCASTER AVENUE | ||||||||
| Address2: | |||||||||
| City: | HAVERFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105254000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2010 | ||||||||
| LastUpdateDate: | 01/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00240700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OC012248 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.