Provider Demographics
NPI:1184012700
Name:COZZA, MIRIAM
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:COZZA
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 1:26691 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1421
Mailing Address - Country:US
Mailing Address - Phone:330-714-0200
Mailing Address - Fax:
Practice Address - Street 1:26691 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1421
Practice Address - Country:US
Practice Address - Phone:330-714-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04522224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant