Provider Demographics
NPI:1255456034
Name:MORT, KAREN RENEE (COTAL)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RENEE
Last Name:MORT
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 E MAIN ST
Mailing Address - Street 2:VALLEY VIEW RETIREMENT COMMUNITY
Mailing Address - City:BELLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17004
Mailing Address - Country:US
Mailing Address - Phone:717-935-2105
Mailing Address - Fax:717-935-5109
Practice Address - Street 1:4702 E MAIN ST
Practice Address - Street 2:VALLEY VIEW RETIREMENT COMMUNITY
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004
Practice Address - Country:US
Practice Address - Phone:717-935-2105
Practice Address - Fax:717-935-5109
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP000475L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant