Individual
JACKIE SUE MISTIATIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
725 COLUMBUS AVE, FOSTORIA, OH 44830-3255
(419) 435-6220
Mailing address
144 N MASTERS CT, MAUMEE, OH 43537-3068
(419) 973-3471
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA007265
OH
Other
Enumeration date
10/08/2018
Last updated
10/08/2018
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