Provider Demographics
NPI:1912620378
Name:HOUGHTON, KEARSTIN RENEE (COTA/L)
Entity type:Individual
Prefix:
First Name:KEARSTIN
Middle Name:RENEE
Last Name:HOUGHTON
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 1:1747 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2212
Mailing Address - Country:US
Mailing Address - Phone:419-975-0448
Mailing Address - Fax:
Practice Address - Street 1:50 BLYMYER AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2343
Practice Address - Country:US
Practice Address - Phone:419-774-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007676224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant