1144666538 NPI number — MRS. KIMBERLY ANN CICHANOWSKY OT

Table of content: MRS. KIMBERLY ANN CICHANOWSKY OT (NPI 1144666538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144666538 NPI number — MRS. KIMBERLY ANN CICHANOWSKY OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CICHANOWSKY
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOULDIN
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144666538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3809 WEST CHESTER PIKE
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
NEWTOWN SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19073-0259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-359-5640
Provider Business Mailing Address Fax Number:
610-359-1519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MCFARLAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNETT SQUARE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19348-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-925-4901
Provider Business Practice Location Address Fax Number:
610-925-4906
Provider Enumeration Date:
05/13/2013

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: 225X00000X , with the licence number:  OC003022L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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