Provider Demographics
NPI:1467586115
Name:FAKE, KARA JANELLE (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:JANELLE
Last Name:FAKE
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 1:223 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2808
Mailing Address - Country:US
Mailing Address - Phone:717-799-3895
Mailing Address - Fax:
Practice Address - Street 1:336 S WEST END AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-5043
Practice Address - Country:US
Practice Address - Phone:717-393-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006222224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant