Provider Demographics
NPI:1992826762
Name:MINROD, GENA M (COTA)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:M
Last Name:MINROD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:NEW PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:17959-1228
Mailing Address - Country:US
Mailing Address - Phone:570-277-6424
Mailing Address - Fax:
Practice Address - Street 1:1000 ORWIGSBURG MANOR DR
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-1303
Practice Address - Country:US
Practice Address - Phone:570-621-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0P002526L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant