Provider Demographics
NPI:1477851921
Name:BUSH, KERI ANNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:ANNE
Last Name:BUSH
Suffix:
Gender:F
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 1:9973 DARROW PARK DR
Mailing Address - Street 2:109
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2612
Mailing Address - Country:US
Mailing Address - Phone:330-715-0755
Mailing Address - Fax:
Practice Address - Street 1:9973 DARROW PARK DR
Practice Address - Street 2:109
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2612
Practice Address - Country:US
Practice Address - Phone:330-715-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA02248224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant