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General NPI Number Information
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NPI Number | 1548894553
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Entity Type | Individual
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Provider Name | MCKENZIE GAMBLE COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 2011 SCOTLAND AVE
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-1451
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Country | US
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Telephone | 717-217-2097
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Fax |
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Provider Business Mailing Address
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Address Line | 676 CUMBERLAND AVE APT B
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City | CHAMBERSBURG
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State | PA
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Zip | 17201-3871
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Country | US
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Telephone | 717-552-1836
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OP009815
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License Number State | PA
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