MEDICARE: GINA INGLESE MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1760061170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA INGLESE MS, OTR/L

Provider Business Mailing Address
First Line	:	3211 RIDING CT
Second Line	:
City	:	CHALFONT
State	:	PA
Zip	:	18914-3745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 NE MARTIN LUTHER KING JR BLVD STE 302
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3579
Country	:	US
Telephone Number	:	971-337-6372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2021
Last Update Date	:	09/23/2021

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