Provider Demographics
NPI:1679781439
Name:TOWNE GARDELLA, KARLA R (COTA L)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:R
Last Name:TOWNE GARDELLA
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 1:14 N STEELE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1302
Mailing Address - Country:US
Mailing Address - Phone:508-831-3571
Mailing Address - Fax:
Practice Address - Street 1:14 N STEELE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1302
Practice Address - Country:US
Practice Address - Phone:508-831-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA934224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant