MEDICARE: STACEY C ATKINS COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	400189201202	OH
2	3747P1801X	Personal Care Attendant		OH
3	376J00000X	Homemaker		OH
4	224Z00000X	Occupational Therapy Assistant		OH
5	374U00000X	Home Health Aide		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073005013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY C ATKINS COTA/L

Provider Business Mailing Address
First Line	:	518 POPLAR AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-3857
Country	:	US
Telephone Number	:	330-617-9971
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 POPLAR AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-3857
Country	:	US
Telephone Number	:	330-617-9971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	03/20/2026

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