Individual
NICOLE DIFFENDERFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1634 W THISTLE DR, WYOMISSING, PA 19610-1273
(610) 301-3259
Mailing address
613 ROSE PETAL LN, MOUNT JOY, PA 17552-3155
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OC012421
PA
Other
Enumeration date
06/30/2015
Last updated
06/30/2015
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