Provider Demographics
NPI:1619306990
Name:KOMARA, VIRGINIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:KOMARA
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 1:300 GREEN GLEN SPUR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1075
Mailing Address - Country:US
Mailing Address - Phone:330-208-0537
Mailing Address - Fax:
Practice Address - Street 1:300 GREEN GLEN SPUR
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1075
Practice Address - Country:US
Practice Address - Phone:330-208-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA03664224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant