Provider Demographics
NPI:1518431550
Name:SANTA, CARLEY JO (COTA/L)
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:JO
Last Name:SANTA
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 1:410 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-1632
Mailing Address - Country:US
Mailing Address - Phone:412-773-0270
Mailing Address - Fax:
Practice Address - Street 1:147 LAFAYETTE MANOR RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8900
Practice Address - Country:US
Practice Address - Phone:724-430-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008643224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant