Individual
CHRISTINE GONGOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4114
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4114
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
431
WV
225X00000X
Occupational Therapist
OC0058120
PA
Other
Enumeration date
09/12/2011
Last updated
12/11/2012
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