Provider Demographics
NPI:1568173227
Name:WARREN, MARIA (COTA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 TANAGER WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3256
Mailing Address - Country:US
Mailing Address - Phone:614-353-6484
Mailing Address - Fax:
Practice Address - Street 1:201 MARGE SCHOTT WAY
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8863
Practice Address - Country:US
Practice Address - Phone:513-583-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA008345224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant