Provider Demographics
NPI:1417074048
Name:PICKARD, TESHA MARIE (COTAL)
Entity Type:Individual
Prefix:
First Name:TESHA
Middle Name:MARIE
Last Name:PICKARD
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 17TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-2075
Mailing Address - Country:US
Mailing Address - Phone:216-584-2720
Mailing Address - Fax:216-587-4806
Practice Address - Street 1:2334 17TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-2075
Practice Address - Country:US
Practice Address - Phone:216-584-2720
Practice Address - Fax:216-587-4806
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA1794224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant