Provider Demographics
NPI:1902384787
Name:ARENTZ, GEORGIA M (OTR)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:M
Last Name:ARENTZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 LINCOLN HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1522
Mailing Address - Country:US
Mailing Address - Phone:717-203-4590
Mailing Address - Fax:
Practice Address - Street 1:502 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4406
Practice Address - Country:US
Practice Address - Phone:717-203-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015785225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC015785OtherOCCUPATIONAL THERAPY LICENSE