Provider Demographics
NPI:1003956558
Name:POULAKOS, HOLLI MARIE (LMT, NMT)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:MARIE
Last Name:POULAKOS
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 BOARDMAN CANFIELD RD # B
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9009
Mailing Address - Country:US
Mailing Address - Phone:330-702-0500
Mailing Address - Fax:330-702-0575
Practice Address - Street 1:3695 BOARDMAN CANFIELD RD # B
Practice Address - Street 2:SUITE 100
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9009
Practice Address - Country:US
Practice Address - Phone:330-702-0500
Practice Address - Fax:330-702-0575
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist