Provider Demographics
NPI:1053753079
Name:HUANG, MAGDALENA (OTR/L)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18255-1530
Mailing Address - Country:US
Mailing Address - Phone:570-427-8683
Mailing Address - Fax:
Practice Address - Street 1:1000 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:WEATHERLY
Practice Address - State:PA
Practice Address - Zip Code:18255-1530
Practice Address - Country:US
Practice Address - Phone:570-427-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012307172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker