Healthcare Provider Details

I. General information

NPI: 1750285664
Provider Name (Legal Business Name): BROOKE DUPLAIN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MCKINLEY AVE NW
CANTON OH
44702-1717
US

IV. Provider business mailing address

305 MCKINLEY AVE NW
CANTON OH
44702-1717
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-2500
  • Fax:
Mailing address:
  • Phone: 330-438-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA006981
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: