Healthcare Provider Details

I. General information

NPI: 1275440372
Provider Name (Legal Business Name): JENNIFER WILLFORD COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W CRAWFORD ST
VAN WERT OH
45891-1903
US

IV. Provider business mailing address

708 BEECHWOOD PL
ELIDA OH
45807-1101
US

V. Phone/Fax

Practice location:
  • Phone: 419-238-0648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA007254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: