MEDICARE: MRS. TONIE MARIE MCGLATHERY PSY.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	OH3175656	OH

General Provider Information

NPI Number	:	1043612336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONIE MARIE MCGLATHERY PSY.S.

Provider Business Mailing Address
First Line	:	10335 DETROIT AVE APT 11B
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1666
Country	:	US
Telephone Number	:	440-666-0364
Fax Number	:	216-295-4546

Provider Business Practice Location Address
First Line	:	3817 MARTIN LUTHER KING JR DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2846
Country	:	US
Telephone Number	:	216-491-5865
Fax Number	:	216-295-4546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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