Provider Demographics
NPI:1689374191
Name:WHITE, MIKALA RICHARDSON (COTA)
Entity type:Individual
Prefix:
First Name:MIKALA
Middle Name:RICHARDSON
Last Name:WHITE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 FLINTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4882
Mailing Address - Country:US
Mailing Address - Phone:740-816-0889
Mailing Address - Fax:
Practice Address - Street 1:2112 CASE PKWY STE 10
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2378
Practice Address - Country:US
Practice Address - Phone:330-425-8474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA008361224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant