Provider Demographics
NPI:1811086499
Name:KLITSCH, LAURA LINDSAY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LINDSAY
Last Name:KLITSCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:LINDSAY
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:69 FOCHT RD
Mailing Address - Street 2:
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551-9649
Mailing Address - Country:US
Mailing Address - Phone:610-693-6666
Mailing Address - Fax:610-693-6666
Practice Address - Street 1:9 BRISTOL CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1851
Practice Address - Country:US
Practice Address - Phone:610-670-8600
Practice Address - Fax:610-670-9104
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC-009011225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1767824OtherHIGHMARK PROVIDER NUMBER