Provider Demographics
NPI:1659523397
Name:KENTON, LYNDA S (COTA)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:S
Last Name:KENTON
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 1:5244 E MIAMI RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-9676
Mailing Address - Country:US
Mailing Address - Phone:513-349-7853
Mailing Address - Fax:
Practice Address - Street 1:5244 E MIAMI RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-9676
Practice Address - Country:US
Practice Address - Phone:513-349-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001089A224Z00000X
OH004169224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant