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General NPI Number Information
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NPI Number | 1730452608
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Entity Type | Individual
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Provider Name | AMY MARIE WEINER COTA/L
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 225 WEST MAIN STREET
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City | SHELBY
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State | OH
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Zip | 44875
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Country | US
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Telephone | 419-342-2440
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E MC CASKEY
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City | DUNKIRK
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State | OH
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Zip | 45836
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Country | US
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Telephone | 419-581-6821
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 04769
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License Number State | OH
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