Provider Demographics
NPI:1063928497
Name:PONGRATZ, BRIANNE ELIZABETH (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:PONGRATZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7296 MCGILL RD
Mailing Address - Street 2:
Mailing Address - City:HARBORCREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16421-1523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1753
Practice Address - Country:US
Practice Address - Phone:814-871-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant