Provider Demographics
NPI:1942809181
Name:BANCROFT, JAMES PATRICK (OTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:BANCROFT
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-2314
Mailing Address - Country:US
Mailing Address - Phone:412-614-0022
Mailing Address - Fax:
Practice Address - Street 1:341 E JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-7306
Practice Address - Country:US
Practice Address - Phone:724-588-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007553224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant