Provider Demographics
NPI:1417072307
Name:DEZOLT, CATHLEEN M (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:M
Last Name:DEZOLT
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 1:123 GRIST MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WEATHERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12400 HIGH BLUFF DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:866-756-0002
Practice Address - Fax:972-983-0290
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004090L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50067445OtherCAPITAL BLUE CROSS