Provider Demographics
NPI:1902389125
Name:DILLER, CHEYENNE LAURA (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:CHEYENNE
Middle Name:LAURA
Last Name:DILLER
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 1:668 CUMBERLAND AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-3869
Mailing Address - Country:US
Mailing Address - Phone:717-830-8220
Mailing Address - Fax:
Practice Address - Street 1:1183 LUTHER DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7407
Practice Address - Country:US
Practice Address - Phone:240-420-4138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009375224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant