Provider Demographics
NPI:1891386058
Name:TRUCHON, KELBY ANN
Entity Type:Individual
Prefix:
First Name:KELBY
Middle Name:ANN
Last Name:TRUCHON
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 1:698 HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SHICKSHINNY
Mailing Address - State:PA
Mailing Address - Zip Code:18655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:698 HILL ROAD
Practice Address - Street 2:
Practice Address - City:SHICKSHINNY
Practice Address - State:PA
Practice Address - Zip Code:18655
Practice Address - Country:US
Practice Address - Phone:570-899-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-31
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA445268225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA445268OtherNBCOT