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General NPI Number Information
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NPI Number | 1114404894
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Entity Type | Individual
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Provider Name | MICHELLE MARMATAKIS COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 536 OLD HOWELL RD
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City | GREENVILLE
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State | SC
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Zip | 29615-1969
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Country | US
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Telephone | 864-244-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 20756 STANFORD AVE
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-1433
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Country | US
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Telephone | 440-668-0239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA007163
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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