Provider Demographics
NPI:1780036442
Name:FARNACK, KEILY
Entity Type:Individual
Prefix:
First Name:KEILY
Middle Name:
Last Name:FARNACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 SAUCON CIR
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-5411
Mailing Address - Country:US
Mailing Address - Phone:484-553-7324
Mailing Address - Fax:
Practice Address - Street 1:2427 SAUCON CIR
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-5411
Practice Address - Country:US
Practice Address - Phone:484-553-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist