Provider Demographics
NPI:1962229872
Name:WHEATLEY, MOREEN LILY (MS, ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:MOREEN
Middle Name:LILY
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-2870
Mailing Address - Country:US
Mailing Address - Phone:610-866-8013
Mailing Address - Fax:
Practice Address - Street 1:3300 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-2870
Practice Address - Country:US
Practice Address - Phone:610-866-8013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20000302672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer