Provider Demographics
NPI:1477984938
Name:DIEDOLF, CHERYL (COTA)
Entity type:Individual
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First Name:CHERYL
Middle Name:
Last Name:DIEDOLF
Suffix:
Gender:F
Credentials:COTA
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Mailing Address - Street 1:787 37TH ST STE E110
Mailing Address - Street 2:INDIAN RIVER HAND & UPPER EXTREMITY REHABILITATION
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7319
Mailing Address - Country:US
Mailing Address - Phone:772-562-6401
Mailing Address - Fax:772-562-6011
Practice Address - Street 1:787 37TH ST STE E110
Practice Address - Street 2:INDIAN RIVER HAND & UPPER EXTREMITY REHABILITATION
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7319
Practice Address - Country:US
Practice Address - Phone:772-562-6401
Practice Address - Fax:772-562-6011
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOTA12864224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant