Provider Demographics
NPI:1629560115
Name:ADAMS, LAVERNA M (COTA)
Entity Type:Individual
Prefix:
First Name:LAVERNA
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LAVERNA
Other - Middle Name:MICHELLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:82 SKYLINE RD
Mailing Address - Street 2:
Mailing Address - City:MAYPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16240-4916
Mailing Address - Country:US
Mailing Address - Phone:814-952-0497
Mailing Address - Fax:
Practice Address - Street 1:82 SKYLINE RD
Practice Address - Street 2:
Practice Address - City:MAYPORT
Practice Address - State:PA
Practice Address - Zip Code:16240-4916
Practice Address - Country:US
Practice Address - Phone:814-952-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2197224Z00000X
NC11056224Z00000X
PAOP008111224Z00000X
SC3744224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant