Provider Demographics
NPI:1174050710
Name:MENDOZA, BERNADETTE (COTA/L)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:MENDOZA
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 1:4110 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 N MALIN RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1429
Practice Address - Country:US
Practice Address - Phone:610-356-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2017-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist