Provider Demographics
NPI:1619272879
Name:BRENGEL, PAULA C (COTA)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:C
Last Name:BRENGEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-9634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MOUNT ALLEN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6171
Practice Address - Country:US
Practice Address - Phone:717-790-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006589224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant