Healthcare Provider Details

I. General information

NPI: 1730004060
Provider Name (Legal Business Name): LYDIA FLOWERS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N QUENTIN RD
NEWARK OH
43055-4623
US

IV. Provider business mailing address

145 N QUENTIN RD
NEWARK OH
43055-4623
US

V. Phone/Fax

Practice location:
  • Phone: 740-349-6084
  • Fax:
Mailing address:
  • Phone: 740-349-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: