Individual
MISS FALLON MARY GOUVEIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, LAT, ATC
Contact information
Practice address
414 PAOLI PIKE, MALVERN, PA 19355-3311
(484) 784-7824
Mailing address
2876 RINGNECK RD, AUDUBON, PA 19403-1817
(484) 784-7824
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
PA
225X00000X
Occupational Therapist
Primary
O3018293
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
PA
Other
Enumeration date
03/07/2019
Last updated
01/28/2025
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