Provider Demographics
NPI:1417668252
Name:THACH, TORIE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TORIE
Middle Name:MARIE
Last Name:THACH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9668 SUNRAY DR
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-4253
Mailing Address - Country:US
Mailing Address - Phone:216-509-6209
Mailing Address - Fax:
Practice Address - Street 1:5275 N ABBE RD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1451
Practice Address - Country:US
Practice Address - Phone:440-934-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.126078.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse