Provider Demographics
NPI:1285992677
Name:GAVACS, MARY F (OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:F
Last Name:GAVACS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8500 # 7642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:814-875-8700
Mailing Address - Fax:814-875-8756
Practice Address - Street 1:1645 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5007
Practice Address - Country:US
Practice Address - Phone:814-875-8700
Practice Address - Fax:814-875-8756
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOC000191L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics