Kelli Dawn Stancovich, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OC008172 Issued in PA

Practice address

429 S Market St
Martinsburg, PA 16662-1005

Phone

(814) 793-5206

Fax

(814) 793-3818

NPI assigned

Nov 9, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Kelli Dawn Bouch Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194895789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 HEMLOCK DR",
            "city": "PORTAGE",
            "state": "PA",
            "postal_code": "159462041",
            "telephone_number": "814-736-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 S MARKET ST",
            "city": "MARTINSBURG",
            "state": "PA",
            "postal_code": "166621005",
            "telephone_number": "814-793-5206",
            "fax_number": "814-793-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANCOVICH",
        "first_name": "KELLI",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC008172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "BOUCH",
            "middle_name": "DAWN",
            "prefix": "MISS",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in Martinsburg, PA
• Providers in Martinsburg, PA by specialty
• Occupational Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.