MEDICARE: MRS. NICHOLE LOFTON ED. 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	OH1272356	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043623374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICHOLE LOFTON ED. S.

Provider Business Mailing Address
First Line	:	9728 E NORTHWOOD DR
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-2806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2215
Country	:	US
Telephone Number	:	216-631-1528
Fax Number	:

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

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/04/2014

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