Provider Demographics
NPI:1912542333
Name:MATTOCKS, TORI NICOLE (COTA)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:NICOLE
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:NICOLE
Other - Last Name:GLISSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1052 LOWERS MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17724
Mailing Address - Country:US
Mailing Address - Phone:570-637-8435
Mailing Address - Fax:
Practice Address - Street 1:15900 US-6
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947
Practice Address - Country:US
Practice Address - Phone:570-297-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATOP009297224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant