Provider Demographics
NPI:1952960890
Name:CHURICO, MADELINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:CHURICO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2769
Mailing Address - Country:US
Mailing Address - Phone:570-581-6259
Mailing Address - Fax:
Practice Address - Street 1:501 THOMAS JONES WAY
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2531
Practice Address - Country:US
Practice Address - Phone:484-873-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009630224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant