Provider Demographics
NPI:1487778627
Name:GILL, CYNTHIA JOY (MSOM, OTRL)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JOY
Last Name:GILL
Suffix:
Gender:F
Credentials:MSOM, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1110
Mailing Address - Country:US
Mailing Address - Phone:570-647-9030
Mailing Address - Fax:570-970-0318
Practice Address - Street 1:440 N RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2631
Practice Address - Country:US
Practice Address - Phone:570-831-8622
Practice Address - Fax:570-970-0318
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003749L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist