Provider Demographics
NPI:1821343476
Name:EDLANTIS ACHIEVEMENT CENTER
Entity Type:Organization
Organization Name:EDLANTIS ACHIEVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESOTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:717-496-9364
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17254-0393
Mailing Address - Country:US
Mailing Address - Phone:717-496-9364
Mailing Address - Fax:717-446-0707
Practice Address - Street 1:3583 SCOTLAND RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND
Practice Address - State:PA
Practice Address - Zip Code:17254-1200
Practice Address - Country:US
Practice Address - Phone:717-496-9364
Practice Address - Fax:717-446-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontologyGroup - Multi-Specialty
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty