Provider Demographics
NPI:1124211685
Name:VAUGHN, WILLIAM PAUL (COTA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PAUL
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 OLNEY LAYTONSVILLE RD
Mailing Address - Street 2:#123
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1734
Mailing Address - Country:US
Mailing Address - Phone:412-527-9206
Mailing Address - Fax:
Practice Address - Street 1:3470 OLNEY LAYTONSVILLE RD
Practice Address - Street 2:#123
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1734
Practice Address - Country:US
Practice Address - Phone:412-527-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00821224Z00000X
PAOP003435L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant