Provider Demographics
NPI:1821292467
Name:SKIAS, JOLENE MICHELLE (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:MICHELLE
Last Name:SKIAS
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 1:181 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-9678
Mailing Address - Country:US
Mailing Address - Phone:610-670-7136
Mailing Address - Fax:
Practice Address - Street 1:1 BOYD STREET
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:PA
Practice Address - Zip Code:17016
Practice Address - Country:US
Practice Address - Phone:717-273-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001803L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA814003OtherFIM CERTIFICATION