Healthcare Provider Details

I. General information

NPI: 1134240872
Provider Name (Legal Business Name): LEAH LORENZ COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 LAKESHORE BLVD
CLEVELAND OH
44110
US

IV. Provider business mailing address

11772 KINGSGATE CT
PERRYSBURG OH
43551-1719
US

V. Phone/Fax

Practice location:
  • Phone: 216-486-2300
  • Fax:
Mailing address:
  • Phone: 419-297-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA3565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: