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General NPI Number Information
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NPI Number | 1306176821
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Entity Type | Individual
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Provider Name | ALISSA LYNNE MATECHAK COTA
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Gender | Female
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 956 E RAILROAD AVE
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City | BRYN MAWR
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State | PA
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Zip | 19010-3831
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Country | US
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Telephone | 610-525-8412
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Fax | 610-527-4236
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Provider Business Mailing Address
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Address Line | 24 ELIAS RD
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City | SPRING BROOK TOWNSHIP
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State | PA
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Zip | 18444-6238
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Country | US
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Telephone | 570-842-9436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OP005973
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License Number State | PA
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