Healthcare Provider Details

I. General information

NPI: 1861587214
Provider Name (Legal Business Name): JOHN C WATSON COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 LOMBARDO CTR STE 205
SEVEN HILLS OH
44131-6962
US

IV. Provider business mailing address

778 PERRY RD
TALLMADGE OH
44278-3363
US

V. Phone/Fax

Practice location:
  • Phone: 330-945-9797
  • Fax:
Mailing address:
  • Phone: 330-945-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: