Provider Demographics
NPI:1548934664
Name:KOTAR, YASZMIN
Entity type:Individual
Prefix:
First Name:YASZMIN
Middle Name:
Last Name:KOTAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-2872
Mailing Address - Country:US
Mailing Address - Phone:724-809-0059
Mailing Address - Fax:
Practice Address - Street 1:2614 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1405
Practice Address - Country:US
Practice Address - Phone:724-626-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017883225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist