Healthcare Provider Details

I. General information

NPI: 1760689855
Provider Name (Legal Business Name): TREA WILL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

6171 HUNTLEY RD SUITE E
COLUMBUS OH
43229-1079
US

IV. Provider business mailing address

6171 HUNTLEY RD SUITE E
COLUMBUS OH
43229-1079
US

V. Phone/Fax

Practice location:
  • Phone: 614-840-0558
  • Fax: 614-840-9310
Mailing address:
  • Phone: 614-840-0558
  • Fax: 614-840-9310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 002942
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: