Provider Demographics
NPI:1043589674
Name:DILLON, LAUREL A (COTA)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:A
Last Name:DILLON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:A
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:47 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-4315
Mailing Address - Country:US
Mailing Address - Phone:845-614-0033
Mailing Address - Fax:
Practice Address - Street 1:47 GOSHEN ROAD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918
Practice Address - Country:US
Practice Address - Phone:845-248-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004076-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant