=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033054994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN SKINNER-KIDD COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2026
-----------------------------------------------------
Last Update Date | 04/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28501 CLEMENS RD
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-572-2737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9781 EVAN MILLER TRL
-----------------------------------------------------
City | OLMSTED TWP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44138-8181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-572-2737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OTA006600
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------