Provider Demographics
NPI:1568013423
Name:REICHLE, MARY (OT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:REICHLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 45784
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5784
Mailing Address - Country:US
Mailing Address - Phone:484-266-0387
Mailing Address - Fax:
Practice Address - Street 1:613 CRICKLEWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8507
Practice Address - Country:US
Practice Address - Phone:484-266-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist