Healthcare Provider Details

I. General information

NPI: 1982511796
Provider Name (Legal Business Name): JOANIE LIGHTLE OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 ARCH ST
CHILLICOTHEE OH
45601-1519
US

IV. Provider business mailing address

1110 OH-220
PIKETON OH
45661-9720
US

V. Phone/Fax

Practice location:
  • Phone: 740-774-1119
  • Fax:
Mailing address:
  • Phone: 740-708-3881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008068
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: