Provider Demographics
NPI:1063016749
Name:WRIGHT-COZART, MARIE ANTONETTE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ANTONETTE
Last Name:WRIGHT-COZART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 MONTICELLO BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2848
Mailing Address - Country:US
Mailing Address - Phone:216-326-1377
Mailing Address - Fax:
Practice Address - Street 1:4926 MONTICELLO BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2848
Practice Address - Country:US
Practice Address - Phone:216-326-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1823245171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty