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General NPI Number Information
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NPI Number | 1710284831
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Entity Type | Individual
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Provider Name | DAYNE M LEWIS COTA/L
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Gender | Male
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 732 BECKMAN ST
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City | DAYTON
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State | OH
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Zip | 45410-2165
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Country | US
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Telephone | 937-253-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 705 E DOROTHY LN
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City | DAYTON
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State | OH
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Zip | 45419-1927
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Country | US
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Telephone |
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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 | OTA. 04593
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | OH
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