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General NPI Number Information
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NPI Number | 1770158289
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Entity Type | Individual
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Provider Name | GIANCARLO PHILIP MORREALE OTR/L
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Gender | Male
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 1400 WAVERLY RD
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City | GLADWYNE
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State | PA
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Zip | 19035-1296
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Country | US
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Telephone | 610-645-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 528 BRIDGE ST
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City | MONT CLARE
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State | PA
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Zip | 19453-5006
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Country | US
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Telephone | 914-826-7538
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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 | OC017715
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License Number State | PA
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