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General NPI Number Information
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NPI Number | 1447790480
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Entity Type | Individual
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Provider Name | NICOLA GENTILLE
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Gender | Male
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 1756 TEMPLE AVE
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-3016
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Country | US
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Telephone | 440-724-6497
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Fax |
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Provider Business Mailing Address
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Address Line | 6218 TALL OAKS DR
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City | MENTOR
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State | OH
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Zip | 44060-3148
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 009359
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License Number State | OH
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