Individual
NATHAN CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
70 COLUMBUS CIR, ATHENS, OH 45701-1370
(740) 592-1000
Mailing address
33 CROSS ST, JACKSON, OH 45640-1511
(740) 339-9807
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
003940
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003940
OHIO OT PT AT BOARD
OH
Enumeration date
01/09/2019
Last updated
01/09/2019
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