Basic Information
| Provider Information | |||||||||
| NPI: | 1891025805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMERSLEY | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MS, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 396 SCHUYLER AVE | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187042728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702876142 | ||||||||
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| Practice Location | |||||||||
| Address1: | 368 TIOGA AVE | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187045117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702879681 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2010 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OP005905 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.