Provider Demographics
NPI:1427362144
Name:ENGEL, JOHANNA SASHA
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:SASHA
Last Name:ENGEL
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 1:1445 CITY LINE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3831
Mailing Address - Country:US
Mailing Address - Phone:610-642-4029
Mailing Address - Fax:610-642-7318
Practice Address - Street 1:1445 CITY LINE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3831
Practice Address - Country:US
Practice Address - Phone:610-642-4029
Practice Address - Fax:610-642-7318
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011047225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist