Provider Demographics
NPI:1437401627
Name:CORDELL, KALA BETTH (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:KALA
Middle Name:BETTH
Last Name:CORDELL
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 1:55 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2207
Mailing Address - Country:US
Mailing Address - Phone:717-264-6815
Mailing Address - Fax:717-264-5757
Practice Address - Street 1:55 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2207
Practice Address - Country:US
Practice Address - Phone:717-264-6815
Practice Address - Fax:717-264-5757
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007021224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant