Provider Demographics
NPI:1871618413
Name:WENTZEL, ERICA K (MOT OTRL)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:K
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:MOT OTRL
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:333 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3535
Mailing Address - Country:US
Mailing Address - Phone:717-519-8869
Mailing Address - Fax:
Practice Address - Street 1:600 EDEN ROAD
Practice Address - Street 2:BUILDING I
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4205
Practice Address - Country:US
Practice Address - Phone:717-299-4829
Practice Address - Fax:717-295-3453
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005385L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016952170005OtherTYPE 17