Healthcare Provider Details

I. General information

NPI: 1801874292
Provider Name (Legal Business Name): NATAHSA A. DOUGHTY C.O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 W SPRAGUE RD SUITE 365
MIDDLEBURG HEIGHTS OH
44130-6318
US

IV. Provider business mailing address

PO BOX 246
NORTH OLMSTED OH
44070-0246
US

V. Phone/Fax

Practice location:
  • Phone: 216-227-7700
  • Fax: 866-848-2496
Mailing address:
  • Phone: 440-777-6017
  • Fax: 440-777-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.00492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: