Provider Demographics
NPI:1447868799
Name:PITTS, JONATHAN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PITTS
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1417
Mailing Address - Country:US
Mailing Address - Phone:419-290-4707
Mailing Address - Fax:
Practice Address - Street 1:725 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-3255
Practice Address - Country:US
Practice Address - Phone:419-937-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist