Healthcare Provider Details

I. General information

NPI: 1255755435
Provider Name (Legal Business Name): HEATHER KINTNER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10095 BRICK CHURCH RD
CAMBRIDGE OH
43725-8550
US

IV. Provider business mailing address

68152 READ RD
CAMBRIDGE OH
43725-9577
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-8977
  • Fax:
Mailing address:
  • Phone: 740-680-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: