Provider Demographics
NPI:1376751396
Name:KORENGOLD, LINDA DALE (OTR)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DALE
Last Name:KORENGOLD
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 1:11927 E REKSOM RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-7166
Mailing Address - Country:US
Mailing Address - Phone:520-723-8444
Mailing Address - Fax:
Practice Address - Street 1:1300 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-1436
Practice Address - Country:US
Practice Address - Phone:928-425-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2740225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation