Provider Demographics
NPI:1235471129
Name:RINEHART-COWAN, DAVA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DAVA
Middle Name:
Last Name:RINEHART-COWAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:PA
Mailing Address - Zip Code:18813-0092
Mailing Address - Country:US
Mailing Address - Phone:570-289-4680
Mailing Address - Fax:
Practice Address - Street 1:225 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-6525
Practice Address - Country:US
Practice Address - Phone:570-278-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002098L172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker