Provider Demographics
NPI:1255950374
Name:KEMMERLY, MIKAYLA KEMMERLY
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:KEMMERLY
Last Name:KEMMERLY
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 1:6014 BAYBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-9030
Mailing Address - Country:US
Mailing Address - Phone:717-951-3479
Mailing Address - Fax:
Practice Address - Street 1:621 S 14TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-1914
Practice Address - Country:US
Practice Address - Phone:717-449-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015437225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist