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General NPI Number Information
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NPI Number | 1639568652
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Entity Type | Individual
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Provider Name | KRISTA MCGUIRE OTA
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Gender | Female
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 20800 WESTGATE MALL STE 500
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-1362
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Country | US
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Telephone | 440-333-1880
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Fax |
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Provider Business Mailing Address
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Address Line | 3705 MELBOURNE AVE
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City | CLEVELAND
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State | OH
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Zip | 44111-5743
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Country | US
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Telephone | 216-409-3207
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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 | 04311
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License Number State | OH
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