Provider Demographics
NPI:1992994834
Name:KLINE, CAROLYN (COTA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:KLINE
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 1:14 BRIDGEWATERS DR STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1184
Mailing Address - Country:US
Mailing Address - Phone:732-542-6600
Mailing Address - Fax:732-542-6606
Practice Address - Street 1:14 BRIDGEWATERS DR STE A
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1184
Practice Address - Country:US
Practice Address - Phone:732-542-6600
Practice Address - Fax:732-542-6606
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09011900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant