Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | OH PTA 5848 | OH |
NPI | 1013315159 |
---|---|
Provider Name | Joan Otto |
First Address | Ashtabula, OH 44004 |
Second Address | Ashtabula, OH 44004-2405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2014 |
Last Update Date | 05/12/2014 |