Healthcare Provider Details

I. General information

NPI: 1760148357
Provider Name (Legal Business Name): OHIO SPORTS & SPINE INSTITUTE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16844 SAINT CLAIR AVE
EAST LIVERPOOL OH
43920-4277
US

IV. Provider business mailing address

16844 SAINT CLAIR AVE
EAST LIVERPOOL OH
43920-4277
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-6500
  • Fax:
Mailing address:
  • Phone: 330-386-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE ANN KLEEH
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 330-758-9400