Provider Demographics
NPI:1780233890
Name:CHANNEL, JOSIE LANE (COTA/L)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:LANE
Last Name:CHANNEL
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 1:2455 STATE ROUTE 93 NE
Mailing Address - Street 2:
Mailing Address - City:CROOKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43731-9424
Mailing Address - Country:US
Mailing Address - Phone:740-586-5157
Mailing Address - Fax:
Practice Address - Street 1:927 SOUTH ST UNIT A
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-6014
Practice Address - Country:US
Practice Address - Phone:740-927-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant