Provider Demographics
NPI:1821225087
Name:EBERLY, ALLISEN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLISEN
Middle Name:
Last Name:EBERLY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 N SHERMAN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9637
Mailing Address - Country:US
Mailing Address - Phone:717-266-9294
Mailing Address - Fax:717-384-8071
Practice Address - Street 1:4880 N SHERMAN STREET EXT
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347-9637
Practice Address - Country:US
Practice Address - Phone:717-266-9294
Practice Address - Fax:717-384-8071
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist