Healthcare Provider Details

I. General information

NPI: 1063240083
Provider Name (Legal Business Name): ALLISON RESETAR OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEBARTOLO PL STE 1100
YOUNGSTOWN OH
44512-7004
US

IV. Provider business mailing address

100 DEBARTOLO PL STE 200
YOUNGSTOWN OH
44512-6095
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-8000
  • Fax: 330-729-8084
Mailing address:
  • Phone: 330-729-8000
  • Fax: 330-729-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT012982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: