Healthcare Provider Details

I. General information

NPI: 1386552701
Provider Name (Legal Business Name): KARLIE MARIE RUDOLPH COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 OH-100
TIFFIN OH
44883
US

IV. Provider business mailing address

790 DUBLIN RD
NORWALK OH
44857-9746
US

V. Phone/Fax

Practice location:
  • Phone: 419-447-7203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number008822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: