Provider Demographics
NPI:1487423034
Name:ROMBERGER, KELLY NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:ROMBERGER
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 1:1601 N 2ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-2401
Mailing Address - Country:US
Mailing Address - Phone:570-991-3626
Mailing Address - Fax:
Practice Address - Street 1:1926 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4701
Practice Address - Country:US
Practice Address - Phone:717-506-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist