Provider Demographics
NPI:1255756557
Name:GREGG, MARIBETH (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:
Last Name:GREGG
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 1:1512 S US HIGHWAY 68
Mailing Address - Street 2:SUITE J100
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9198
Mailing Address - Country:US
Mailing Address - Phone:937-484-1557
Mailing Address - Fax:
Practice Address - Street 1:1600 MUTUAL UNION RD N
Practice Address - Street 2:
Practice Address - City:CABLE
Practice Address - State:OH
Practice Address - Zip Code:43009-9608
Practice Address - Country:US
Practice Address - Phone:937-652-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-23
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH224Z00000X224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant