MEDICARE: EDU-AT-TECH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347B00000X	Bus
2	251300000X	Local Education Agency (LEA)	OH1213349	OH
3	225CA2400X	Assistive Technology Practitioner Rehabilitation Counselor	1816075	OH
4	225CA2500X	Assistive Technology Supplier Rehabilitation Counselor	1816075	OH
5	231HA2400X	Assistive Technology Practitioner Audiologist	SP8177	OH
6	291U00000X	Clinical Medical Laboratory	36D2045034	OH
7	103K00000X	Behavior Analyst	1816075	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437443140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDU-AT-TECH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 91666
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-3666
Country	:	US
Telephone Number	:	216-217-0561
Fax Number	:	216-848-1202

Provider Business Practice Location Address
First Line	:	3618 RAYMONT BLVD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-2617
Country	:	US
Telephone Number	:	216-217-0561
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, BEHAVIOR THERAPIST
Name	:	DR. ARIES NICHELLE COBB
Credential	:	PH.D.
Telephone Number	:	216-217-0561

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	12/27/2012

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Directions to “EDU-AT-TECH, LLC ” Practice Location

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