Provider Demographics
NPI:1801157136
Name:KAY, MARK (OT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KAY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1458
Mailing Address - Country:US
Mailing Address - Phone:814-833-2301
Mailing Address - Fax:814-833-9230
Practice Address - Street 1:4202 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1458
Practice Address - Country:US
Practice Address - Phone:814-833-2301
Practice Address - Fax:814-833-9230
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113967YGNYMedicare PIN