Healthcare Provider Details

I. General information

NPI: 1215454954
Provider Name (Legal Business Name): SAMANTHA PUCCI COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 38TH ST NW
CANTON OH
44709-2312
US

IV. Provider business mailing address

7089 MANCHESTER RD
NEW FRANKLIN OH
44614-9502
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-8136
  • Fax:
Mailing address:
  • Phone: 330-933-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA006856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: