Provider Demographics
NPI:1578764692
Name:GINGRAS, JOHANNA (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:GINGRAS
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 GARRISON WAY
Mailing Address - Street 2:
Mailing Address - City:GULPH MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2513
Mailing Address - Country:US
Mailing Address - Phone:610-527-3981
Mailing Address - Fax:
Practice Address - Street 1:30 WEST AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3322
Practice Address - Country:US
Practice Address - Phone:610-293-2595
Practice Address - Fax:610-995-1350
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003517L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant