Healthcare Provider Details

I. General information

NPI: 1891666947
Provider Name (Legal Business Name): MICHAELA TEDRICK COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 COLUMBUS RD
CENTERBURG OH
43011-9401
US

IV. Provider business mailing address

3023 APPLE VALLEY DR
HOWARD OH
43028-8308
US

V. Phone/Fax

Practice location:
  • Phone: 740-625-5401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA007259
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: