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General NPI Number Information
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NPI Number | 1033732508
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Entity Type | Individual
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Provider Name | ABIGAIL ELLA GORE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 105 S PIKE RD
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City | SARVER
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State | PA
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Zip | 16055-9283
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Country | US
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Telephone | 724-272-3844
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Fax |
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Provider Business Mailing Address
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Address Line | 129 MEADOWBROOK RD
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City | RENFREW
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State | PA
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Zip | 16053-1213
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Country | US
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Telephone | 724-713-7328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC016962
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License Number State | PA
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