Provider Demographics
NPI:1912338567
Name:FOSTER, PERRY L (COTA/L)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:L
Last Name:FOSTER
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 1:4936 SOLAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1726
Mailing Address - Country:US
Mailing Address - Phone:614-315-4075
Mailing Address - Fax:
Practice Address - Street 1:1652 OLD HENDERSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3618
Practice Address - Country:US
Practice Address - Phone:614-459-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-05342314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility