Provider Demographics
NPI:1861617144
Name:KOTEY, THEODORA BOTOR (LPN)
Entity type:Individual
Prefix:
First Name:THEODORA
Middle Name:BOTOR
Last Name:KOTEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:THEODORA
Other - Middle Name:BOTOR
Other - Last Name:KOTEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2079 MARGO RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5770
Mailing Address - Country:US
Mailing Address - Phone:614-841-7797
Mailing Address - Fax:
Practice Address - Street 1:2079 MARGO RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5770
Practice Address - Country:US
Practice Address - Phone:614-841-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117757164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse