Provider Demographics
NPI:1336391614
Name:PETERS, DARLENE KAY (COTA/L)
Entity type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:KAY
Last Name:PETERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 STOUFFER AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2938
Mailing Address - Country:US
Mailing Address - Phone:717-263-0436
Mailing Address - Fax:
Practice Address - Street 1:1070 STOUFFER AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2938
Practice Address - Country:US
Practice Address - Phone:717-263-0436
Practice Address - Fax:717-263-6629
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001897L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant