Provider Demographics
NPI:1396181848
Name:OVIATT, PAUL JOSEPH (COTA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:OVIATT
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SANDYS WAY
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ME
Mailing Address - Zip Code:04258-5021
Mailing Address - Country:US
Mailing Address - Phone:423-418-2279
Mailing Address - Fax:
Practice Address - Street 1:12 SANDYS WAY
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ME
Practice Address - Zip Code:04258-5021
Practice Address - Country:US
Practice Address - Phone:423-418-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000451251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health