Basic Information
| Provider Information | |||||||||
| NPI: | 1831198605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN DRIESEN | ||||||||
| FirstName: | DENICE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | O.T.R./L. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Practice Location | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 01/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC002857L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0422737000 | 01 | KEYSTONE HEALTH EAST | OTHER | 2420161 | 01 | CIGNA HEALTHCARE | OTHER | 0422737000 | 01 | INDEPENDENCE BLUE CROSS | OTHER | 2170728 | 01 | MAMSI | OTHER | 0422737000 | 01 | AMERIHEALTH | OTHER | 2202022 | 01 | UNITED HEALTHCARE | OTHER | 821772 | 01 | FIRST PRIORITY HEALTH | OTHER | 47241 | 01 | GEISINGER HEALTH PLAN | OTHER | 962641 | 01 | HIGHMARK BLUE SHIELD | OTHER | 02223802 | 01 | CAPITAL BLUE CROSS | OTHER | 850162 | 01 | AETNA PPO | OTHER | 315283 | 01 | HEALTHAMERICA/HEALTHASSUR | OTHER | 02223802 | 01 | KEYSTONE HEALTH CENTRAL | OTHER | P1643788 | 01 | OXFORD HEALTH PLANS | OTHER |