Provider Demographics
NPI:1710635776
Name:NEELY, KAREN KATHLEEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:KATHLEEN
Last Name:NEELY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8927
Mailing Address - Country:US
Mailing Address - Phone:610-509-9154
Mailing Address - Fax:
Practice Address - Street 1:7219 MYRTLE DR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8927
Practice Address - Country:US
Practice Address - Phone:610-509-9154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009968224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant