Provider Demographics
NPI:1740477728
Name:ABBOTT, M. EDNA (COTA)
Entity type:Individual
Prefix:
First Name:M. EDNA
Middle Name:
Last Name:ABBOTT
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 1:113 W MCMURRAY RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2427
Mailing Address - Country:US
Mailing Address - Phone:724-941-3080
Mailing Address - Fax:
Practice Address - Street 1:113 W MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2427
Practice Address - Country:US
Practice Address - Phone:724-941-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003354L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant