1578623823 NPI number — MRS. SALLY ANN FETTERMAN MS CCCSLP

Table of content: MRS. SALLY ANN FETTERMAN MS CCCSLP (NPI 1578623823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578623823 NPI number — MRS. SALLY ANN FETTERMAN MS CCCSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FETTERMAN
Provider First Name:
SALLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCCSLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KISSINGER
Provider Other First Name:
SALLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS CCCSLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578623823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1825 S MOUNTAIN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SINKING SPRING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-796-8705
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 BRISTOL COURT
Provider Second Line Business Practice Location Address:
THE CENTER FOR PEDIATRIC THERAPY INC
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-678-8600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL002964L ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)