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General NPI Number Information
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NPI Number | 1861091761
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Entity Type | Individual
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Provider Name | MOLLY GUZIK COTA/L, CDP
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Gender | Female
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 600 W NATIONAL RD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1469
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Country | US
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Telephone | 937-540-0174
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Fax |
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Provider Business Mailing Address
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Address Line | 103 PEGGYS PATH CT
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City | UNION
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State | OH
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Zip | 45322-8752
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Country | US
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Telephone | 937-572-3164
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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 | OTA2315
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License Number State | OH
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