Provider Demographics
NPI:1083871750
Name:GOSSACK, BARBARA JO (OTR)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JO
Last Name:GOSSACK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 W WILSON ST APT C1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2460
Mailing Address - Country:US
Mailing Address - Phone:503-997-9940
Mailing Address - Fax:
Practice Address - Street 1:543 W WILSON ST APT C1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2460
Practice Address - Country:US
Practice Address - Phone:503-997-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1007458225X00000X
CA14041225X00000X
AZ5288225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist