Healthcare Provider Details

I. General information

NPI: 1992129407
Provider Name (Legal Business Name): MAUREEN KOVACH NEWELL B.A., COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEBARTOLO PL SUITE 220
BOARDMAN OH
44512-7011
US

IV. Provider business mailing address

100 DEBARTOLO PL SUITE 220
BOARDMAN OH
44512-7011
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-7828
  • Fax:
Mailing address:
  • Phone: 330-965-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.00695
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: