Basic Information
Provider Information | |||||||||
NPI: | 1598712408 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KOSITS-DEMARCO | ||||||||
FirstName: | ADRIANA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | OT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2 W 10TH ST | ||||||||
Address2: |   | ||||||||
City: | MARCUS HOOK | ||||||||
State: | PA | ||||||||
PostalCode: | 190614513 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6108598850 | ||||||||
FaxNumber: | 6108597876 | ||||||||
Practice Location | |||||||||
Address1: | 1651 53 PULASKI HWY | ||||||||
Address2: |   | ||||||||
City: | BEAR | ||||||||
State: | DE | ||||||||
PostalCode: | 197011453 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3028341550 | ||||||||
FaxNumber: | 3028341549 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/27/2006 | ||||||||
LastUpdateDate: | 03/22/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | U10000809 | DE | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   | 225X00000X | OC008864 | PA | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 3780952000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | P00359624 | 01 | DE | MEDICARE RAILROAD | OTHER | 102556918-0001 | 05 | PA |   | MEDICAID | 1598712408 | 05 | DE |   | MEDICAID | 000051060 | 01 | DE | DPCI | OTHER | 2141327 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |