Healthcare Provider Details

I. General information

NPI: 1124950563
Provider Name (Legal Business Name): JILLANN BERNS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 PECK RD
MANTUA OH
44255-9505
US

IV. Provider business mailing address

10600 PECK RD
MANTUA OH
44255-9505
US

V. Phone/Fax

Practice location:
  • Phone: 330-221-7634
  • Fax:
Mailing address:
  • Phone: 330-221-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA007601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: