Provider Demographics
NPI:1992039739
Name:SHRECKENGAST, BOBBIE KAREN (COTA/L)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:KAREN
Last Name:SHRECKENGAST
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 BLUEJAY LN
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-8922
Mailing Address - Country:US
Mailing Address - Phone:570-246-4020
Mailing Address - Fax:
Practice Address - Street 1:3201 RIVER RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9255
Practice Address - Country:US
Practice Address - Phone:570-522-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-27
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002959L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant