Provider Demographics
NPI:1851689749
Name:MIKESELL, DENNIS (COTA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:MIKESELL
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 ROAD 6
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-9252
Mailing Address - Country:US
Mailing Address - Phone:419-275-2270
Mailing Address - Fax:
Practice Address - Street 1:1603 ROAD 6
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-9252
Practice Address - Country:US
Practice Address - Phone:419-275-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04662224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant