Provider Demographics
NPI:1558302828
Name:BINGAMAN, KORY DAVID (OT)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:DAVID
Last Name:BINGAMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-2800
Mailing Address - Country:US
Mailing Address - Phone:570-524-4446
Mailing Address - Fax:570-522-1110
Practice Address - Street 1:900 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-2800
Practice Address - Country:US
Practice Address - Phone:570-524-4446
Practice Address - Fax:570-522-1110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003421L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist