1205188000 NPI number — BRITTANY TAYLOR LEALI LMT

Table of content: MRS. NICOLE CLEM (NPI 1417784406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205188000 NPI number — BRITTANY TAYLOR LEALI LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEALI
Provider First Name:
BRITTANY
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205188000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24932 AURORA RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44146-1790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-439-5385
Provider Business Mailing Address Fax Number:
440-439-5384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27700 EUCLID AVE # B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUCLID
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44132-3531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-289-2632
Provider Business Practice Location Address Fax Number:
216-289-2654
Provider Enumeration Date:
10/04/2012

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: 225700000X , with the licence number:  33.018004 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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