Provider Demographics
NPI:1699669770
Name:KOTIS, MARYLYNN
Entity type:Individual
Prefix:
First Name:MARYLYNN
Middle Name:
Last Name:KOTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 BEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4437
Mailing Address - Country:US
Mailing Address - Phone:330-792-5719
Mailing Address - Fax:
Practice Address - Street 1:131 N KIMBERLY AVE APT 22
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1845
Practice Address - Country:US
Practice Address - Phone:330-953-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care