Provider Demographics
NPI:1851789622
Name:CAREY, MIRANDA JEANNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JEANNE
Last Name:CAREY
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 1:5141 NEWTON FALLS RD LOT 102
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8856
Mailing Address - Country:US
Mailing Address - Phone:330-845-0506
Mailing Address - Fax:
Practice Address - Street 1:101 S BISSELL RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-9170
Practice Address - Country:US
Practice Address - Phone:330-562-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant