Healthcare Provider Details

I. General information

NPI: 1962825422
Provider Name (Legal Business Name): THOMAS EDWARD SABO SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5897 WINCHELL RD
HIRAM OH
44234-9785
US

IV. Provider business mailing address

5897 WINCHELL RD
HIRAM OH
44234-9785
US

V. Phone/Fax

Practice location:
  • Phone: 330-388-8497
  • Fax:
Mailing address:
  • Phone: 330-388-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSA 12527
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 12527
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 5816
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: