Provider Demographics
NPI:1417306283
Name:MANGIERI SNURKOWSKI, KATHLEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MANGIERI SNURKOWSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SNURKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1693 COUNTY HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:NY
Mailing Address - Zip Code:13796
Mailing Address - Country:US
Mailing Address - Phone:570-441-2501
Mailing Address - Fax:
Practice Address - Street 1:200 BERWICK RD
Practice Address - Street 2:
Practice Address - City:ORANGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17859
Practice Address - Country:US
Practice Address - Phone:570-683-5036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-12
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003497L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist