Provider Demographics
NPI:1962524579
Name:GORCZYCA, TRISHELL DAWN (OTRL)
Entity type:Individual
Prefix:
First Name:TRISHELL
Middle Name:DAWN
Last Name:GORCZYCA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12538 CAMINITO MIRA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2386
Mailing Address - Country:US
Mailing Address - Phone:916-365-3015
Mailing Address - Fax:
Practice Address - Street 1:1609 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1046
Practice Address - Country:US
Practice Address - Phone:619-588-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8019225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics