Healthcare Provider Details

I. General information

NPI: 1790074714
Provider Name (Legal Business Name): INTEGRATIONS TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28700 EUCLID AVE #120
WICKLIFFE OH
44092-2527
US

IV. Provider business mailing address

28700 EUCLID AVE #120
WICKLIFFE OH
44092-2527
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-7607
  • Fax: 440-943-7803
Mailing address:
  • Phone: 440-943-7607
  • Fax: 440-943-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELLEN DENISE WINNEY
Title or Position: ASSISTANT DIRECTOR
Credential: OTR/L
Phone: 21684901215