Provider Demographics
NPI:1548777113
Name:KING, MINDY JANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:JANE
Last Name:KING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:JANE
Other - Last Name:KING-NAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:246 S 44TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6408
Mailing Address - Country:US
Mailing Address - Phone:412-378-3140
Mailing Address - Fax:
Practice Address - Street 1:246 S 44TH ST APT 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-6408
Practice Address - Country:US
Practice Address - Phone:412-378-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014710225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist