Provider Demographics
NPI:1669779609
Name:HOSPDOR-EARNEST, JUDY ANN (COTA)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:HOSPDOR-EARNEST
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 1:15 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-1225
Mailing Address - Country:US
Mailing Address - Phone:610-678-6885
Mailing Address - Fax:
Practice Address - Street 1:945 DUKE ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7216
Practice Address - Country:US
Practice Address - Phone:717-273-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006936224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant