Provider Demographics
NPI:1700121845
Name:LINDGREN, GWENETH (OTR)
Entity Type:Individual
Prefix:MS
First Name:GWENETH
Middle Name:
Last Name:LINDGREN
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 1:33 E BENEZET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3515
Mailing Address - Country:US
Mailing Address - Phone:215-248-6080
Mailing Address - Fax:
Practice Address - Street 1:33 E BENEZET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3515
Practice Address - Country:US
Practice Address - Phone:215-248-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012339225X00000X
NJ46TR00526500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist