Organization
GENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLEY ANN TICE COTA/L (CERTIFIED OCCUPATIONAL THERAPIS)
(330) 424-1504
Entity
Organization
Contact information
Practice address
2511 BENTLEY DR, SALEM, OH 44460-2503
(330) 337-3015
Mailing address
44755 MIDDLE BEAVER RD, LISBON, OH 44432-9556
(330) 424-1504
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1087
OH
Other
Enumeration date
07/02/2010
Last updated
07/02/2010
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