Provider Demographics
NPI:1184008419
Name:MOTOR CONTROL RESTORATION
Entity Type:Organization
Organization Name:MOTOR CONTROL RESTORATION
Other - Org Name:MOTOR CONTROL RESTORATION, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-346-5673
Mailing Address - Street 1:21403 CHAGRIN BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5322
Mailing Address - Country:US
Mailing Address - Phone:216-346-5673
Mailing Address - Fax:
Practice Address - Street 1:21403 CHAGRIN BLVD STE 212
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5322
Practice Address - Country:US
Practice Address - Phone:216-346-5673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH135741Medicare PIN