Provider Demographics
NPI:1962699140
Name:SHEEDY, GWENDA LEE KLEIN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:GWENDA
Middle Name:LEE KLEIN
Last Name:SHEEDY
Suffix:
Gender:F
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 1:3273 HARNESS LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3819
Mailing Address - Country:US
Mailing Address - Phone:215-947-5479
Mailing Address - Fax:
Practice Address - Street 1:602 S BETHLEHEM PIKE
Practice Address - Street 2:STE A-2
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5800
Practice Address - Country:US
Practice Address - Phone:215-643-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002361L171W00000X, 174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor
No174400000XOther Service ProvidersSpecialist