Provider Demographics
NPI:1750969606
Name:EDIXON, AMY LOUISE (COTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:EDIXON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:WINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:80 W 44TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6957
Mailing Address - Country:US
Mailing Address - Phone:440-213-1923
Mailing Address - Fax:
Practice Address - Street 1:2026 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010-9711
Practice Address - Country:US
Practice Address - Phone:440-275-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.04368224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant