Healthcare Provider Details

I. General information

NPI: 1912379488
Provider Name (Legal Business Name): HEATHER DELLENBAUGH I COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 LEE RD
FOLLANSBEE WV
26037-1783
US

IV. Provider business mailing address

840 LEE RD
FOLLANSBEE WV
26037-1783
US

V. Phone/Fax

Practice location:
  • Phone: 304-527-1100
  • Fax:
Mailing address:
  • Phone: 304-527-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP008047
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberX1995
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: