Individual
MRS. LAKE MINOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
143 ROLLING PARK DR N, MASSILLON, OH 44647-8812
(330) 605-8878
Mailing address
143 ROLLING PARK DR N, MASSILLON, OH 44647-8812
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
04611
OH
Other
Enumeration date
08/05/2014
Last updated
08/05/2014
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