Healthcare Provider Details

I. General information

NPI: 1790024271
Provider Name (Legal Business Name): MAGGIE LEE MILNE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13315 N PALMYRA RD
NORTH JACKSON OH
44451-9776
US

IV. Provider business mailing address

13315 N PALMYRA RD
NORTH JACKSON OH
44451-9776
US

V. Phone/Fax

Practice location:
  • Phone: 330-360-1338
  • Fax:
Mailing address:
  • Phone: 330-360-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number04755
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number02463
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberA01941
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: