Provider Demographics
NPI:1568530913
Name:REALE, KAREN KINZIE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KINZIE
Last Name:REALE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SILVERLEAF DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-9520
Mailing Address - Country:US
Mailing Address - Phone:717-805-1497
Mailing Address - Fax:
Practice Address - Street 1:7 SILVERLEAF DR
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-9520
Practice Address - Country:US
Practice Address - Phone:717-805-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002246L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000035240004Medicaid