Provider Demographics
NPI:1619036837
Name:DOLAN, VICTORIA A (OT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:A
Last Name:DOLAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1364
Mailing Address - Country:US
Mailing Address - Phone:814-864-6650
Mailing Address - Fax:814-806-2557
Practice Address - Street 1:500 MARKET ST STE 103
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2998
Practice Address - Country:US
Practice Address - Phone:724-728-7550
Practice Address - Fax:724-647-1570
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006359224Z00000X
PAOC015335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC012185OtherLICENSE NUMBER