Healthcare Provider Details

I. General information

NPI: 1225362031
Provider Name (Legal Business Name): CAROL LYNN BEVELHEIMER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 MAUS DR
NORTH HUNTINGDON PA
15642-2057
US

IV. Provider business mailing address

249 MAUS DR
NORTH HUNTINGDON PA
15642-2057
US

V. Phone/Fax

Practice location:
  • Phone: 724-863-9118
  • Fax: 724-863-8334
Mailing address:
  • Phone: 724-863-9118
  • Fax: 724-863-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP005790
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: