Healthcare Provider Details

I. General information

NPI: 1568859577
Provider Name (Legal Business Name): MR. FELIX CORREA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 CLAYMORE BLVD
RICHMOND HEIGHTS OH
44143-1712
US

IV. Provider business mailing address

347 CLAYMORE BLVD
RICHMOND HEIGHTS OH
44143-1712
US

V. Phone/Fax

Practice location:
  • Phone: 216-268-3600
  • Fax: 216-451-4805
Mailing address:
  • Phone: 216-268-3600
  • Fax: 216-451-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA03294
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: