Healthcare Provider Details

I. General information

NPI: 1851411250
Provider Name (Legal Business Name): HELEN LANANNE SMITHVALDIVIA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HELEN LANANNE SMITH

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W GIRARD AVE
PHILADELPHIA PA
19130-1400
US

IV. Provider business mailing address

544 S 2ND ST
DARBY PA
19023-3105
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-0800
  • Fax:
Mailing address:
  • Phone: 610-586-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP002180-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: