Provider Demographics
NPI:1063513562
Name:WOLFE, DAVID MICHAEL (OTR/L)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:WOLFE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 TURNERS POND DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN UNIVERSITY
Mailing Address - State:PA
Mailing Address - Zip Code:19352-1757
Mailing Address - Country:US
Mailing Address - Phone:610-869-6316
Mailing Address - Fax:
Practice Address - Street 1:1011 W BALTIMORE PIKE STE 105
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9447
Practice Address - Country:US
Practice Address - Phone:610-869-2901
Practice Address - Fax:610-869-1721
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0C004132L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396713Medicare ID - Type UnspecifiedMEDICARE ID NUMBER