Provider Demographics
NPI:1366911158
Name:MERIDIONALE, BIANCA LINDA (OT)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:LINDA
Last Name:MERIDIONALE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:LINDA
Other - Last Name:ANGSTADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 COMMUNITY WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2301
Mailing Address - Country:US
Mailing Address - Phone:717-393-0425
Mailing Address - Fax:717-455-3838
Practice Address - Street 1:625 COMMUNITY WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2301
Practice Address - Country:US
Practice Address - Phone:717-393-0425
Practice Address - Fax:717-735-6009
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
PAOC016000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035789100012Medicaid