Provider Demographics
NPI:1215168737
Name:MACKLIN, MONICA JEAN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:JEAN
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2508
Mailing Address - Country:US
Mailing Address - Phone:330-332-0317
Mailing Address - Fax:330-332-0318
Practice Address - Street 1:250 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2508
Practice Address - Country:US
Practice Address - Phone:330-332-0317
Practice Address - Fax:330-332-0318
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-01994224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant