Provider Demographics
NPI:1508073917
Name:MIDDLETON, DARLENE ELSIE (COTA)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:ELSIE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1002 CAPTAINS QUARTERS DR APT 20
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-2346
Mailing Address - Country:US
Mailing Address - Phone:704-922-4196
Mailing Address - Fax:
Practice Address - Street 1:710 S MARIETTA ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4355
Practice Address - Country:US
Practice Address - Phone:704-861-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4665224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant