Provider Demographics
NPI:1992821441
Name:STANISLAW, KATHY JOANNE (OTA)
Entity type:Individual
Prefix:MISS
First Name:KATHY
Middle Name:JOANNE
Last Name:STANISLAW
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:JOANNE
Other - Last Name:BEROSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:21 S HELLERTOWN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1771
Mailing Address - Country:US
Mailing Address - Phone:610-737-7481
Mailing Address - Fax:
Practice Address - Street 1:3485 DAVISVILLE RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-4220
Practice Address - Country:US
Practice Address - Phone:215-830-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002941L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant