Provider Demographics
NPI:1578558516
Name:STEIN, KENNETH (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-0656
Mailing Address - Country:US
Mailing Address - Phone:267-255-4484
Mailing Address - Fax:610-337-7997
Practice Address - Street 1:251 HEARTHSTONE RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2224
Practice Address - Country:US
Practice Address - Phone:610-337-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006336L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA045413Medicare ID - Type Unspecified