Healthcare Provider Details

I. General information

NPI: 1265653125
Provider Name (Legal Business Name): STACY MAE EYLER COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SOUTH SECOND STREET
CHAMBERSBURG PA
17201
US

IV. Provider business mailing address

9811 MENTZER GAP ROAD
WAYNESBORO PA
17268
US

V. Phone/Fax

Practice location:
  • Phone: 717-264-6815
  • Fax:
Mailing address:
  • Phone: 717-762-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP006074
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: