Healthcare Provider Details

I. General information

NPI: 1437434255
Provider Name (Legal Business Name): MARY K HILS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 CARVER WOODS DR
BLUE ASH OH
45242-5529
US

IV. Provider business mailing address

4440 CARVER WOODS DR
BLUE ASH OH
45242-5529
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-5688
  • Fax: 513-791-0023
Mailing address:
  • Phone: 513-791-5688
  • Fax: 513-791-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA02882
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: