Healthcare Provider Details

I. General information

NPI: 1164758447
Provider Name (Legal Business Name): JENNIFER DAWN MILLS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WESTBOURNE DR
CINCINNATI OH
45248-5127
US

IV. Provider business mailing address

3301 WESTBOURNE DR
CINCINNATI OH
45248-5127
US

V. Phone/Fax

Practice location:
  • Phone: 513-451-1551
  • Fax: 513-451-1534
Mailing address:
  • Phone: 513-451-1551
  • Fax: 513-451-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.02623
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: