Healthcare Provider Details

I. General information

NPI: 1558648840
Provider Name (Legal Business Name): VINCENT GREGORY NAUGHTON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CHURCH RD REHAB DEPARTMENT
WYNCOTE PA
19095-1800
US

IV. Provider business mailing address

1245 CHURCH RD REHAB DEPARTMENT
WYNCOTE PA
19095-1800
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-9990
  • Fax: 215-884-5575
Mailing address:
  • Phone: 215-884-9990
  • Fax: 215-884-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOC002222L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: