Healthcare Provider Details

I. General information

NPI: 1295490381
Provider Name (Legal Business Name): ZEN KOTORI LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 LAFAYETTE RD STE 240
MEDINA OH
44256-3705
US

IV. Provider business mailing address

437 LAFAYETTE RD STE 240
MEDINA OH
44256-3705
US

V. Phone/Fax

Practice location:
  • Phone: 330-975-0737
  • Fax:
Mailing address:
  • Phone: 330-975-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.022787
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: