Healthcare Provider Details

I. General information

NPI: 1780569061
Provider Name (Legal Business Name): QIERRA DENISE SPATES I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 E 40TH ST
CLEVELAND OH
44103-4331
US

IV. Provider business mailing address

2081 E 40TH ST
CLEVELAND OH
44103-4331
US

V. Phone/Fax

Practice location:
  • Phone: 216-668-7413
  • Fax:
Mailing address:
  • Phone: 216-688-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT015495
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: