Provider Demographics
NPI:1659596443
Name:DORDEA, CAROL ANN (COTA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:DORDEA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10787 N D DR
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-9727
Mailing Address - Country:US
Mailing Address - Phone:260-582-9173
Mailing Address - Fax:
Practice Address - Street 1:17374 N 89TH AVE
Practice Address - Street 2:#1522
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8118
Practice Address - Country:US
Practice Address - Phone:260-582-9173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3839224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant