Provider Demographics
NPI:1619694452
Name:PERSKY, MIKALA (OTR)
Entity Type:Individual
Prefix:
First Name:MIKALA
Middle Name:
Last Name:PERSKY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BERNE RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-8906
Mailing Address - Country:US
Mailing Address - Phone:484-269-6554
Mailing Address - Fax:
Practice Address - Street 1:999 W HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-4801
Practice Address - Country:US
Practice Address - Phone:717-944-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist