Provider Demographics
NPI:1801881321
Name:HANCZAR, SHELLEY LYNN (REGISTERED OCCUPATIO)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LYNN
Last Name:HANCZAR
Suffix:
Gender:F
Credentials:REGISTERED OCCUPATIO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:310 PENN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2044
Mailing Address - Country:US
Mailing Address - Phone:814-695-2923
Mailing Address - Fax:814-695-2924
Practice Address - Street 1:7448 WOODBURY PIKE
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1600
Practice Address - Country:US
Practice Address - Phone:814-224-5566
Practice Address - Fax:814-224-2474
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002319L225X00000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA371913OtherHIGHMARK