Provider Demographics
NPI:1881846616
Name:BENDER, NICOLE J (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:J
Last Name:BENDER
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 1:100 CREEK VIEW DRIVE
Mailing Address - Street 2:PO BOX 615
Mailing Address - City:JONESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17038-0615
Mailing Address - Country:US
Mailing Address - Phone:610-781-3395
Mailing Address - Fax:
Practice Address - Street 1:425 BUTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1101
Practice Address - Country:US
Practice Address - Phone:610-373-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006122224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant