Healthcare Provider Details

I. General information

NPI: 1912773318
Provider Name (Legal Business Name): OLIVIA COTTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVE
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

15631 W RIVER RD
COLUMBIA STATION OH
44028-9011
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-7000
  • Fax:
Mailing address:
  • Phone: 330-256-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0036124
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number451377
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: