Provider Demographics
NPI:1891112462
Name:GINNONA, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GINNONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HASTINGS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-8614
Mailing Address - Country:US
Mailing Address - Phone:484-880-0305
Mailing Address - Fax:
Practice Address - Street 1:425 BUTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1101
Practice Address - Country:US
Practice Address - Phone:610-363-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006885224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant