Provider Demographics
NPI:1750651261
Name:WOLFINBARGER, JOSIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:WOLFINBARGER
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 1:3246 E OLD STONE RD
Mailing Address - Street 2:APT D106
Mailing Address - City:BROOKLINE
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9620
Mailing Address - Country:US
Mailing Address - Phone:417-827-4302
Mailing Address - Fax:
Practice Address - Street 1:101 E STATE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3109
Practice Address - Country:US
Practice Address - Phone:610-925-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011017490224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant