Healthcare Provider Details

I. General information

NPI: 1124633896
Provider Name (Legal Business Name): TYLER JAY LAGUARDIA COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 ASHLAND AVE
LORAIN OH
44052-4450
US

IV. Provider business mailing address

1885 LAKE AVE
ELYRIA OH
44035-2551
US

V. Phone/Fax

Practice location:
  • Phone: 440-830-4500
  • Fax:
Mailing address:
  • Phone: 440-324-5777
  • Fax: 440-324-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: