Provider Demographics
NPI:1972636355
Name:KIRSCH, MARTIN ARCHIBALD (OTR-L)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ARCHIBALD
Last Name:KIRSCH
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 1:835 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3629
Mailing Address - Country:US
Mailing Address - Phone:724-357-7068
Mailing Address - Fax:724-357-6984
Practice Address - Street 1:835 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3629
Practice Address - Country:US
Practice Address - Phone:724-357-7068
Practice Address - Fax:724-357-6984
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001813735OtherHMO
PA1016209430002Medicaid