Provider Demographics
NPI:1407440340
Name:KLANICA, CARLIE MADELLE (OTR)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:MADELLE
Last Name:KLANICA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2757 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3138
Mailing Address - Country:US
Mailing Address - Phone:724-337-6522
Mailing Address - Fax:724-337-0630
Practice Address - Street 1:1316 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-1447
Practice Address - Country:US
Practice Address - Phone:724-274-4333
Practice Address - Fax:724-274-4303
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017512225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist