Provider Demographics
NPI:1649758467
Name:GORSKI, FALLON ROSE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:ROSE
Last Name:GORSKI
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 1:150 CHAMBERLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8648
Mailing Address - Country:US
Mailing Address - Phone:570-593-5484
Mailing Address - Fax:
Practice Address - Street 1:150 CHAMBERLAINE AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-8648
Practice Address - Country:US
Practice Address - Phone:570-593-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015089225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist