Basic Information
| Provider Information | |||||||||
| NPI: | 1619152204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORECKI | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LAUREN | ||||||||
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| Credential: | MS, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1930 CHESTNUT ST | ||||||||
| Address2: | APT. 5 A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191034522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153171974 | ||||||||
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| Practice Location | |||||||||
| Address1: | 455 S GULPH RD | ||||||||
| Address2: | EXECUTIVE TERRACE SUITE 230 | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194063114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109920555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 01/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | OC010414 | PA | Y | Other Service Providers | Specialist |
No ID Information.