Provider Demographics
NPI:1124504899
Name:KARDOS, JOY ALLISON (COTA)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:ALLISON
Last Name:KARDOS
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 1:38260 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7810
Mailing Address - Country:US
Mailing Address - Phone:440-530-0270
Mailing Address - Fax:
Practice Address - Street 1:1515 BROOKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-8210
Practice Address - Country:US
Practice Address - Phone:440-226-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007280224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant