Healthcare Provider Details

I. General information

NPI: 1902453392
Provider Name (Legal Business Name): BRIDGETTE BECKER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 RIDDLE RD
CINCINNATI OH
45220-2411
US

IV. Provider business mailing address

3701 HARRISON AVE APT 2
CINCINNATI OH
45211-4765
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-8001
  • Fax:
Mailing address:
  • Phone: 513-305-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA007435
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: