Provider Demographics
NPI:1790024271
Name:MILNE, MAGGIE LEE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:MAGGIE
Middle Name:LEE
Last Name:MILNE
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 1:13315 N PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:44451-9776
Mailing Address - Country:US
Mailing Address - Phone:330-360-1338
Mailing Address - Fax:
Practice Address - Street 1:13315 N PALMYRA RD
Practice Address - Street 2:
Practice Address - City:NORTH JACKSON
Practice Address - State:OH
Practice Address - Zip Code:44451-9776
Practice Address - Country:US
Practice Address - Phone:330-360-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04755225X00000X
CA02463225X00000X
MDA01941225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04755OtherOHIO OCCUPATIONAL STATE LICENSURE
MDA01941OtherMARYLAND OCCUPATIONAL THERAPY LICENSURE
CA2463OtherCALIFORNIA OCCUPATIONAL STATE LICENSURE