Healthcare Provider Details

I. General information

NPI: 1669008892
Provider Name (Legal Business Name): JOHN SCOTT ASHCRAFT COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 LANSDOWNE AVE
CINCINNATI OH
45236-3150
US

IV. Provider business mailing address

4139 LANSDOWNE AVE
CINCINNATI OH
45236-3150
US

V. Phone/Fax

Practice location:
  • Phone: 513-568-3623
  • Fax: 855-232-8604
Mailing address:
  • Phone: 513-568-3623
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number006787
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: