Healthcare Provider Details

I. General information

NPI: 1316161946
Provider Name (Legal Business Name): VICKI L LOVEJOY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 WHIPPLE AVE NW SUITE 200
CANTON OH
44708-6215
US

IV. Provider business mailing address

4645 BELPAR ST NW
CANTON OH
44718-3602
US

V. Phone/Fax

Practice location:
  • Phone: 330-478-1752
  • Fax: 330-478-1763
Mailing address:
  • Phone: 330-493-4210
  • Fax: 330-493-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA-02956
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: