Healthcare Provider Details

I. General information

NPI: 1508068792
Provider Name (Legal Business Name): LORI EKSTEIN OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 BAYARD RD
CLEVELAND OH
44121-3117
US

IV. Provider business mailing address

4137 BAYARD ROAD
CLEVELAND OH
44121
US

V. Phone/Fax

Practice location:
  • Phone: 216-382-7967
  • Fax:
Mailing address:
  • Phone: 216-382-7967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA02089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: