Provider Demographics
NPI:1013410109
Name:CARLIN, DESIREE LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:LYNN
Last Name:CARLIN
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 1:404 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1927
Mailing Address - Country:US
Mailing Address - Phone:215-850-9486
Mailing Address - Fax:
Practice Address - Street 1:100 EDELLA RD
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-1628
Practice Address - Country:US
Practice Address - Phone:570-586-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008636224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOP008636OtherCOTA/L