Healthcare Provider Details

I. General information

NPI: 1629223102
Provider Name (Legal Business Name): KARYL L DIMENICHI COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARYL L BRUNO COTA/L

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ROUTE 70 E SUITE 103
CHERRY HILL NJ
08034-2210
US

IV. Provider business mailing address

113 INDIAN RIDGE LN
TELFORD PA
18969-2265
US

V. Phone/Fax

Practice location:
  • Phone: 800-670-3893
  • Fax:
Mailing address:
  • Phone: 215-703-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License NumberOP002534L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License NumberOP002534L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: