Provider Demographics
NPI:1922116821
Name:KLISS, JOANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:KLISS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 PHEASANT RD
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-7426
Mailing Address - Country:US
Mailing Address - Phone:717-469-7185
Mailing Address - Fax:
Practice Address - Street 1:55 MILLER ST
Practice Address - Street 2:
Practice Address - City:SUMMERDALE
Practice Address - State:PA
Practice Address - Zip Code:17093-0489
Practice Address - Country:US
Practice Address - Phone:717-732-8400
Practice Address - Fax:717-732-8414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0C000706L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist