Individual
MARY T. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
111 BRIDGE ST, TIONESTA, PA 16353-9737
(814) 827-8776
(814) 827-6345
Mailing address
111 BRIDGE ST, TIONESTA, PA 16353-9737
(814) 827-8776
(814) 827-6345
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP002755L
PA
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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