1760407142 NPI number — MS. ALEEA FAIRLIGHT TOLEDO OTRL

Table of content: MS. ALEEA FAIRLIGHT TOLEDO OTRL (NPI 1760407142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760407142 NPI number — MS. ALEEA FAIRLIGHT TOLEDO OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOLEDO
Provider First Name:
ALEEA
Provider Middle Name:
FAIRLIGHT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCOTT
Provider Other First Name:
ALEEA
Provider Other Middle Name:
FAIRLIGHT
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760407142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 DECATUR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-2721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-264-5668
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3311 BURNT MILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-251-5817
Provider Business Practice Location Address Fax Number:
910-251-2652
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  3999 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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