Provider Demographics
NPI:1033732508
Name:GORE, ABIGAIL ELLA (OTR/L)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELLA
Last Name:GORE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RENFREW
Mailing Address - State:PA
Mailing Address - Zip Code:16053-1213
Mailing Address - Country:US
Mailing Address - Phone:724-713-7328
Mailing Address - Fax:
Practice Address - Street 1:105 S PIKE RD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9283
Practice Address - Country:US
Practice Address - Phone:724-272-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016962225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty