Provider Demographics
NPI:1912759655
Name:EDWARDS, KERRI (COTA/L)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:EDWARDS
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 1:6690 EDWARDS RD NE
Mailing Address - Street 2:
Mailing Address - City:MINERAL CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44656-8993
Mailing Address - Country:US
Mailing Address - Phone:330-827-0448
Mailing Address - Fax:
Practice Address - Street 1:7951 PITTSBURG AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5669
Practice Address - Country:US
Practice Address - Phone:330-491-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.02147224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant