Provider Demographics
NPI:1407538408
Name:OVIATT 26611
Entity Type:Organization
Organization Name:OVIATT 26611
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-219-3453
Mailing Address - Street 1:26611 E OVIATT RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2446
Mailing Address - Country:US
Mailing Address - Phone:216-219-3453
Mailing Address - Fax:
Practice Address - Street 1:26611 E OVIATT RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2446
Practice Address - Country:US
Practice Address - Phone:216-219-3453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency