Provider Demographics
NPI:1124167192
Name:WECKERLY, KATHALENE A (OTR)
Entity type:Individual
Prefix:MS
First Name:KATHALENE
Middle Name:A
Last Name:WECKERLY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 US HIGHWAY 522 S
Mailing Address - Street 2:
Mailing Address - City:MC VEYTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17051-9429
Mailing Address - Country:US
Mailing Address - Phone:814-542-8630
Mailing Address - Fax:814-542-4970
Practice Address - Street 1:2109 US HIGHWAY 522 S
Practice Address - Street 2:
Practice Address - City:MC VEYTOWN
Practice Address - State:PA
Practice Address - Zip Code:17051-9429
Practice Address - Country:US
Practice Address - Phone:814-542-8630
Practice Address - Fax:814-542-4970
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396765Medicare ID - Type Unspecified