Provider Demographics
NPI:1043649692
Name:OSWALD, JAMES BERNARD (COTA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BERNARD
Last Name:OSWALD
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MI
Mailing Address - Zip Code:48880-1018
Mailing Address - Country:US
Mailing Address - Phone:989-217-1476
Mailing Address - Fax:
Practice Address - Street 1:508 RANDOM LN
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9304
Practice Address - Country:US
Practice Address - Phone:989-732-3508
Practice Address - Fax:989-732-0389
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007261224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant