Individual
MRS. CATHLEEN M DEZOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
12400 HIGH BLUFF DRIVE, SUITE 100, SAN DIEGO, CA 92130
(866) 756-0002
(972) 983-0290
Mailing address
123 GRIST MILL ROAD, WEATHERLY, PA 18255
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC004090L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50067445
CAPITAL BLUE CROSS
PA
Enumeration date
03/20/2007
Last updated
07/08/2007
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