Healthcare Provider Details

I. General information

NPI: 1689855793
Provider Name (Legal Business Name): JULIE A KOTOWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE SIDES DRAKE PA-C

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W EXCHANGE ST
AKRON OH
44302-1709
US

IV. Provider business mailing address

2651 W MARKET ST
FAIRLAWN OH
44333-4200
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-4428
  • Fax: 330-535-4451
Mailing address:
  • Phone: 330-864-8008
  • Fax: 330-864-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-000771
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: