1134938111 NPI number — LOGAN OLIVIA TOTH MA, CTRS, CT

Table of content: LOGAN OLIVIA TOTH MA, CTRS, CT (NPI 1134938111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134938111 NPI number — LOGAN OLIVIA TOTH MA, CTRS, CT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOTH
Provider First Name:
LOGAN
Provider Middle Name:
OLIVIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CTRS, CT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSS
Provider Other First Name:
LOGAN
Provider Other Middle Name:
OLIVIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CTRS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134938111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
937 FORESTBROOK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAINESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44077-7603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-251-6885
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8251 MAYFIELD RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44026-2567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-299-7909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2025

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: 101Y00000X , with the licence number:  C.2406420-TRNE , 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)