Provider Demographics
NPI:1790820934
Name:DODD, RITA (OTRL, CHT)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 E PERKINS AVE
Mailing Address - Street 2:SUITE E, BOX 6
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7998
Mailing Address - Country:US
Mailing Address - Phone:419-627-2526
Mailing Address - Fax:419-627-4263
Practice Address - Street 1:2419 E PERKINS AVE
Practice Address - Street 2:SUITE E, BOX 6
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7998
Practice Address - Country:US
Practice Address - Phone:419-627-2526
Practice Address - Fax:419-627-4263
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-02085225X00000X
OHOT-2085225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055666Medicaid
OH000000168180OtherANTHEM BCBS
OH0055666Medicaid