Provider Demographics
NPI:1700460623
Name:O'CONNER, GEORGIA ELIZABETH MARIE
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:ELIZABETH MARIE
Last Name:O'CONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 JOHN B MERRILL PKWY APT 1
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1442
Mailing Address - Country:US
Mailing Address - Phone:570-721-5205
Mailing Address - Fax:
Practice Address - Street 1:37 JOHN B MERRILL PKWY APT 1
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1442
Practice Address - Country:US
Practice Address - Phone:570-721-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA224Z00000X
PAOP010012224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty