Provider Demographics
NPI:1508371881
Name:POBORSKI, LOREN PAIGE (COTA)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:PAIGE
Last Name:POBORSKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LOREN
Other - Middle Name:
Other - Last Name:PRIBISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-0870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:807 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2942
Practice Address - Country:US
Practice Address - Phone:814-255-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008005224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant