Provider Demographics
NPI:1255837662
Name:DOLAN, ALINE M (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ALINE
Middle Name:M
Last Name:DOLAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RAVINE LN
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5741
Mailing Address - Country:US
Mailing Address - Phone:845-744-8125
Mailing Address - Fax:
Practice Address - Street 1:22 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2118
Practice Address - Country:US
Practice Address - Phone:845-794-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009579-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant