Healthcare Provider Details

I. General information

NPI: 1699970475
Provider Name (Legal Business Name): DAVID R JOHNSON COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 GOVERNORS HILL DR SUITE 180
CINCINNATI OH
45249-1372
US

IV. Provider business mailing address

4943 DENNY LN
DAYTON OH
45431-2020
US

V. Phone/Fax

Practice location:
  • Phone: 800-791-5766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA02857
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: