Provider Demographics
NPI:1710062906
Name:WILLISON, JUDITH D (COTA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:D
Last Name:WILLISON
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:PO BOX 6062
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-0062
Mailing Address - Country:US
Mailing Address - Phone:330-630-1860
Mailing Address - Fax:330-630-3198
Practice Address - Street 1:161 NORTHWEST AVE
Practice Address - Street 2:STE. 104
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1850
Practice Address - Country:US
Practice Address - Phone:330-630-1860
Practice Address - Fax:330-630-3198
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01233224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant