Provider Demographics
NPI:1548560931
Name:RANG, GENA LEE (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:GENA
Middle Name:LEE
Last Name:RANG
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-1643
Mailing Address - Country:US
Mailing Address - Phone:570-640-3321
Mailing Address - Fax:
Practice Address - Street 1:2200 1ST AVE
Practice Address - Street 2:PROVIDENCE PLACE
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2065
Practice Address - Country:US
Practice Address - Phone:570-628-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002849L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist