Provider Demographics
NPI:1295033280
Name:PAVLIKOSKI, PAUL J (OT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:PAVLIKOSKI
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 214
Mailing Address - Street 2:KUNILLE RD
Mailing Address - City:HARVEYS LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18618-9649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 214
Practice Address - Street 2:KUNKLE RD
Practice Address - City:HARVEYS LAKE
Practice Address - State:PA
Practice Address - Zip Code:18618-9649
Practice Address - Country:US
Practice Address - Phone:215-238-9848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist