Provider Demographics
NPI:1821215732
Name:KOLECKI, KATIE LYNNE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:LYNNE
Last Name:KOLECKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:LYNNE
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2167 LONGVIEW RD.
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976
Mailing Address - Country:US
Mailing Address - Phone:610-597-3729
Mailing Address - Fax:215-343-2772
Practice Address - Street 1:2167 LONGVIEW RD.
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976
Practice Address - Country:US
Practice Address - Phone:610-597-3729
Practice Address - Fax:215-343-2772
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
PAOC006233L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001901914Medicaid