Provider Demographics
NPI:1093905390
Name:KOWALCYK, SANDRA (COTA/L)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KOWALCYK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 PINE GLEN RD
Mailing Address - Street 2:
Mailing Address - City:MOSHANNON
Mailing Address - State:PA
Mailing Address - Zip Code:16859-9310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 CLIFFSIDE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7662
Practice Address - Country:US
Practice Address - Phone:814-235-2034
Practice Address - Fax:814-235-6223
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOPOOO145L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant