MEDICARE: DAYNE M LEWIS COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA. 04593	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		OH

General Provider Information

NPI Number	:	1710284831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYNE M LEWIS COTA/L

Provider Business Mailing Address
First Line	:	705 E DOROTHY LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-1927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 BECKMAN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-2165
Country	:	US
Telephone Number	:	937-253-1820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	01/24/2024

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