=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619152204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY LAUREN GORECKI MS, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2008
-----------------------------------------------------
Last Update Date | 01/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 S GULPH RD EXECUTIVE TERRACE SUITE 230
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-992-0555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1930 CHESTNUT ST APT. 5 A
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-317-1974
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | OC010414
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------