Provider Demographics
NPI:1770782724
Name:DEWIEL, ANTOINETTE MICHALINE (COTA)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:MICHALINE
Last Name:DEWIEL
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 1:101 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2713
Mailing Address - Country:US
Mailing Address - Phone:716-694-0029
Mailing Address - Fax:
Practice Address - Street 1:101 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-2713
Practice Address - Country:US
Practice Address - Phone:716-694-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004754-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant