Healthcare Provider Details

I. General information

NPI: 1215661343
Provider Name (Legal Business Name): PEPSI-LYNN HARCOURT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 YOUNGSTOWN WARREN RD STE A
NILES OH
44446-4626
US

IV. Provider business mailing address

950 YOUNGSTOWN WARREN RD STE A
NILES OH
44446-4626
US

V. Phone/Fax

Practice location:
  • Phone: 330-505-1606
  • Fax: 330-423-4555
Mailing address:
  • Phone: 330-505-1606
  • Fax: 330-423-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009437
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: