Healthcare Provider Details

I. General information

NPI: 1710284831
Provider Name (Legal Business Name): DAYNE M LEWIS COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 BECKMAN ST
DAYTON OH
45410-2165
US

IV. Provider business mailing address

705 E DOROTHY LN
DAYTON OH
45419-1927
US

V. Phone/Fax

Practice location:
  • Phone: 937-253-1820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA. 04593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: