Provider Demographics
NPI:1346578671
Name:KREIDER, KERRY LYNN (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LYNN
Last Name:KREIDER
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:LYNN
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5945 REEVES RD
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1530
Mailing Address - Country:US
Mailing Address - Phone:717-581-5202
Mailing Address - Fax:
Practice Address - Street 1:333 WHEAT RIDGE DR
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8558
Practice Address - Country:US
Practice Address - Phone:717-354-1858
Practice Address - Fax:717-354-1873
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009063225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395805OtherPROVIDER NUMBER