Individual
GRACE BERNADETTE FARRELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT/L
Contact information
Practice address
2101 SIMPSON HOUSE, PHILADELPHIA, PA 19131
(215) 878-3600
Mailing address
219 CARLTON DR, BROOMALL, PA 19008-3805
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
OC012852
PA
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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