Provider Demographics
NPI:1164404752
Name:SALAS-MAMARY, LINDA M (MS OTRL CHT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:SALAS-MAMARY
Suffix:
Gender:F
Credentials:MS OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COMMUNITY DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8985
Mailing Address - Country:US
Mailing Address - Phone:570-839-9975
Mailing Address - Fax:570-839-9274
Practice Address - Street 1:100 COMMUNITY DR
Practice Address - Street 2:SUITE 207
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8985
Practice Address - Country:US
Practice Address - Phone:570-839-9975
Practice Address - Fax:570-839-9274
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005914L225X00000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0325890000OtherBLUE SHIELD
PA50017331OtherCAPITAL BLUE CROSS
PA35365OtherBLUE SHIELD
PA807285OtherFIRST PRIORITY
PA2101568OtherAETNA