Provider Demographics
NPI:1033509294
Name:HIRNEISEN, GAYLE
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:HIRNEISEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EAST CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:REAMSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17567
Mailing Address - Country:US
Mailing Address - Phone:484-794-5857
Mailing Address - Fax:
Practice Address - Street 1:24 EAST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:REAMSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17567
Practice Address - Country:US
Practice Address - Phone:484-794-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006603224Z00000X
CA2898224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant