Provider Demographics
NPI:1184164485
Name:MAZALESKI, AMY (COTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MAZALESKI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-3223
Mailing Address - Country:US
Mailing Address - Phone:215-439-3168
Mailing Address - Fax:
Practice Address - Street 1:660 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2361
Practice Address - Country:US
Practice Address - Phone:215-361-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant