Provider Demographics
NPI:1003193269
Name:DYLAG, DARLENE CAROL (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:CAROL
Last Name:DYLAG
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 1:2383 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9640
Mailing Address - Country:US
Mailing Address - Phone:171-688-0417
Mailing Address - Fax:
Practice Address - Street 1:2383 MAIN RD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9640
Practice Address - Country:US
Practice Address - Phone:171-688-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant