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General NPI Number Information
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NPI Number | 1386028389
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Entity Type | Individual
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Provider Name | LEIGH FOTHERINGHAM COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 800 MARKET AVE. NORTH
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City | CANTON
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State | OH
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Zip | 44702
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Country | US
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Telephone | 330-456-1014
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Fax |
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Provider Business Mailing Address
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Address Line | 10 ATWATER
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City | LIMAVILLE
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State | OH
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Zip | 44640
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Country | US
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Telephone | 330-206-9202
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OTA.06087
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License Number State | OH
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