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General NPI Number Information
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NPI Number | 1629982467
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Entity Type | Individual
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Provider Name | DUSTIN M HERBERT COTA/L
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Gender | Male
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 21 BIRGE DR
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City | CHAUNCEY
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State | OH
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Zip | 45719-1100
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Country | US
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Telephone | 740-797-0064
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Fax | 440-578-7330
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Provider Business Mailing Address
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Address Line | 69 WEST ST
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City | JACKSON
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State | OH
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Zip | 45640-1566
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Country | US
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Telephone | 740-418-4441
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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 | OTA06661
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License Number State | OH
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