Healthcare Provider Details

I. General information

NPI: 1831387406
Provider Name (Legal Business Name): TIMOTHY PATRICK BANISH SR. COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
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

1610 BRUCE AVE
CINCINNATI OH
45223-2002
US

V. Phone/Fax

Practice location:
  • Phone: 866-791-5766
  • Fax: 513-683-1500
Mailing address:
  • Phone: 513-542-6847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA02490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: