Healthcare Provider Details

I. General information

NPI: 1568790681
Provider Name (Legal Business Name): AMBER GOTSCHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10056 GERDANVILLE AVE SE
WAYNESBURG OH
44688-9322
US

IV. Provider business mailing address

10056 GERDANVILLE AVE SE
WAYNESBURG OH
44688-9322
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-9316
  • Fax:
Mailing address:
  • Phone: 330-866-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: