Healthcare Provider Details

I. General information

NPI: 1962337758
Provider Name (Legal Business Name): LORI MARIUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5763 TALMADGE RD STE B1
TOLEDO OH
43623-1555
US

IV. Provider business mailing address

5960 STEWART RD
SYLVANIA OH
43560-1540
US

V. Phone/Fax

Practice location:
  • Phone: 419-540-1976
  • Fax:
Mailing address:
  • Phone: 419-215-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.007379
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: