Provider Demographics
NPI:1669597654
Name:PURCELL, MARK (OTR)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PURCELL
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W ELM ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3067
Mailing Address - Country:US
Mailing Address - Phone:570-561-4904
Mailing Address - Fax:
Practice Address - Street 1:200 S MEADE ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6221
Practice Address - Country:US
Practice Address - Phone:570-823-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007434L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist