Provider Demographics
NPI:1457674277
Name:HINTZ, BRIAN JON (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JON
Last Name:HINTZ
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-1814
Mailing Address - Country:US
Mailing Address - Phone:440-390-9818
Mailing Address - Fax:
Practice Address - Street 1:8304 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-1814
Practice Address - Country:US
Practice Address - Phone:440-390-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA04107224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant