Provider Demographics
NPI:1114575065
Name:SUMMERS, DOROTHY AGNES (OT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:AGNES
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N PROVIDENCE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2049
Mailing Address - Country:US
Mailing Address - Phone:610-891-1636
Mailing Address - Fax:
Practice Address - Street 1:1400 N PROVIDENCE RD STE 210
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2049
Practice Address - Country:US
Practice Address - Phone:610-891-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012657225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist