Healthcare Provider Details

I. General information

NPI: 1699669770
Provider Name (Legal Business Name): MARYLYNN KOTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N KIMBERLY AVE APT 22
YOUNGSTOWN OH
44515-1845
US

IV. Provider business mailing address

1384 BEXLEY DR
YOUNGSTOWN OH
44515-4437
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-0820
  • Fax:
Mailing address:
  • Phone: 330-792-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: