Provider Demographics
NPI:1891025805
Name:HAMERSLEY, BRENDA LEE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:HAMERSLEY
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 1:396 SCHUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-2728
Mailing Address - Country:US
Mailing Address - Phone:570-287-6142
Mailing Address - Fax:
Practice Address - Street 1:368 TIOGA AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5117
Practice Address - Country:US
Practice Address - Phone:570-287-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP005905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist