Healthcare Provider Details

I. General information

NPI: 1255456034
Provider Name (Legal Business Name): KAREN RENEE MORT COTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4702 E MAIN ST VALLEY VIEW RETIREMENT COMMUNITY
BELLEVILLE PA
17004
US

IV. Provider business mailing address

4702 E MAIN ST VALLEY VIEW RETIREMENT COMMUNITY
BELLEVILLE PA
17004
US

V. Phone/Fax

Practice location:
  • Phone: 717-935-2105
  • Fax: 717-935-5109
Mailing address:
  • Phone: 717-935-2105
  • Fax: 717-935-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP000475L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: