MEDICARE: LEANNE MARIE MOGISH OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC005539L	PA

General Provider Information

NPI Number	:	1982910063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANNE MARIE MOGISH OTR/L

Provider Business Mailing Address
First Line	:	520 PHILADELPHIA ST
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-3902
Country	:	US
Telephone Number	:	724-463-7478
Fax Number	:	724-463-0931

Provider Business Practice Location Address
First Line	:	1072 MARKET ST
Second Line	:
City	:	SUNBURY
State	:	PA
Zip	:	17801-2458
Country	:	US
Telephone Number	:	570-286-0100
Fax Number	:	570-286-4176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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