1811883739 NPI number — ROOTED IN WELLNESS OCCUPATIONAL THERAPY

Table of content: KELLY SUSAN CORBINE LCSW (NPI 1720396500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811883739 NPI number — ROOTED IN WELLNESS OCCUPATIONAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROOTED IN WELLNESS OCCUPATIONAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811883739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1235 PENN AVE STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-939-9717
Provider Business Mailing Address Fax Number:
610-743-8533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1235 PENN AVE STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-939-9717
Provider Business Practice Location Address Fax Number:
610-743-8533
Provider Enumeration Date:
06/16/2025

Additional Information

Authorized Official

Authorized Official Last Name:
DANBY
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
484-797-9801

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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