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General NPI Number Information
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NPI Number | 1750969606
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Entity Type | Individual
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Provider Name | AMY LOUISE EDIXON COTA
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 2026 STATE ROUTE 45
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City | AUSTINBURG
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State | OH
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Zip | 44010-9711
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Country | US
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Telephone | 440-275-3019
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Fax |
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Provider Business Mailing Address
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Address Line | 80 W 44TH ST APT 3
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City | ASHTABULA
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State | OH
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Zip | 44004-6957
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Country | US
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Telephone | 440-213-1923
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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.04368
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License Number State | OH
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