Provider Demographics
NPI:1164639860
Name:TRESSA, DAVID (COTAIL)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TRESSA
Suffix:
Gender:M
Credentials:COTAIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 REAR SOUTH RIVER ST
Mailing Address - Street 2:APT A
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705
Mailing Address - Country:US
Mailing Address - Phone:570-239-5274
Mailing Address - Fax:
Practice Address - Street 1:149 SOUTH HUNTER HIGHWAY
Practice Address - Street 2:THERAPY DEPT
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222
Practice Address - Country:US
Practice Address - Phone:570-788-7321
Practice Address - Fax:570-788-7267
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001986L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist