MEDICARE: MIKAYLAS MISSION

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1164366944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKAYLAS MISSION

Provider Business Mailing Address
First Line	:	7801 PROUTY RD
Second Line	:
City	:	LODI
State	:	OH
Zip	:	44254-9614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 E WATERLOO RD STE 104
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-3818
Country	:	US
Telephone Number	:	330-933-4795
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MRS. LISA KAY COUGHENOUR
Credential	:
Telephone Number	:	330-933-4795

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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1740124510 — LISA COUGHENOUR
Practice Location Address:

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1942144175 — OLIVIA MARTIN
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1013870930 — SUMMIT WOUND CARE AND LIMB SALVAGE
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Directions to “MIKAYLAS MISSION ” Practice Location

Language	Start Address	Practice Location

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