Healthcare Provider Details

I. General information

NPI: 1114875978
Provider Name (Legal Business Name): SANDRA JEANNE JOHNSON VETTEL COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 SALIDA RD
MENTOR ON THE LAKE OH
44060-2720
US

IV. Provider business mailing address

7515 SALIDA RD
MENTOR ON THE LAKE OH
44060-2720
US

V. Phone/Fax

Practice location:
  • Phone: 440-796-7886
  • Fax:
Mailing address:
  • Phone: 440-796-7886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008126
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1139
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: