=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386768885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA M SNYDER COTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 DOGWOOD DR
-----------------------------------------------------
City | PHILIPSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16866-1982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-342-8434
-----------------------------------------------------
Fax | 814-342-2164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 166 GAME RESERVE RD
-----------------------------------------------------
City | PHILIPSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16866-9336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-342-0358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OP000933L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------