Provider Demographics
NPI:1184054793
Name:TACHIE-MENSON, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TACHIE-MENSON
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 1:6163 MULBERRY CT
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1035
Mailing Address - Country:US
Mailing Address - Phone:267-614-0542
Mailing Address - Fax:
Practice Address - Street 1:6163 MULBERRY CT
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-1035
Practice Address - Country:US
Practice Address - Phone:267-614-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07284225X00000X
PAOC015255225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist