Healthcare Provider Details

I. General information

NPI: 1023307535
Provider Name (Legal Business Name): LEE ANN LINCOLN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14548 BAYMAN ST NW
NORTH LAWRENCE OH
44666-9705
US

IV. Provider business mailing address

14548 BAYMAN ST NW
NORTH LAWRENCE OH
44666-9705
US

V. Phone/Fax

Practice location:
  • Phone: 330-428-4122
  • Fax:
Mailing address:
  • Phone: 330-428-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA3109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: