Provider Demographics
NPI:1205164258
Name:SZAGOLA, BREIA (MSOTR/L)
Entity type:Individual
Prefix:
First Name:BREIA
Middle Name:
Last Name:SZAGOLA
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 LANDMARK CT
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7935
Mailing Address - Country:US
Mailing Address - Phone:717-264-3550
Mailing Address - Fax:
Practice Address - Street 1:6375 CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17222-8350
Practice Address - Country:US
Practice Address - Phone:717-360-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012112225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist