Provider Demographics
NPI:1215137757
Name:ECKENRODE, CYNTHIA KAY (COTA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:ECKENRODE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-0319
Mailing Address - Country:US
Mailing Address - Phone:814-696-5201
Mailing Address - Fax:814-696-5260
Practice Address - Street 1:OLD ROUTE 220 MEADOWS INTERSECTION
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-696-5201
Practice Address - Fax:814-696-5260
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001510L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant