Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | I.0900019 | OH |
NPI | 1003140039 |
---|---|
Provider Name | Carmen K Kottha |
First Address | Beachwood, OH 44122-5648 |
Second Address | Beachwood, OH 44122-5648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2009 |
Last Update Date | 07/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0268768 | (05) | OH |