Healthcare Provider Details

I. General information

NPI: 1487708269
Provider Name (Legal Business Name): BETH MAE SELLERS COTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71370 JAMES MERRITT LANE
ST CLAIRSVILLE OH
43950
US

IV. Provider business mailing address

71370 JAMES MERRITT LANE
ST CLAIRSVILLE OH
43950
US

V. Phone/Fax

Practice location:
  • Phone: 740-968-1080
  • Fax:
Mailing address:
  • Phone: 740-968-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number051264
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC1427
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: