Provider Demographics
NPI:1205233566
Name:WORMUTH, HOPE (COTA/L)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:
Last Name:WORMUTH
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 1:1864 N TOWNSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3550
Mailing Address - Country:US
Mailing Address - Phone:570-883-5700
Mailing Address - Fax:570-883-7017
Practice Address - Street 1:1864 N TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3550
Practice Address - Country:US
Practice Address - Phone:570-883-5700
Practice Address - Fax:570-883-7017
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003242L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant