Provider Demographics
NPI:1609825025
Name:MINNICK, GREGG DAVID (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:DAVID
Last Name:MINNICK
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-8604
Mailing Address - Country:US
Mailing Address - Phone:724-962-2349
Mailing Address - Fax:
Practice Address - Street 1:3404 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-8604
Practice Address - Country:US
Practice Address - Phone:724-962-2349
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004344L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist