Provider Demographics
NPI:1437443140
Name:EDU-AT-TECH, LLC
Entity Type:Organization
Organization Name:EDU-AT-TECH, LLC
Other - Org Name:EDUCATIONAL ASSISTIVE TECHNOLOGY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BEHAVIOR THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIES
Authorized Official - Middle Name:NICHELLE
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-217-0561
Mailing Address - Street 1:PO BOX 91666
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-3666
Mailing Address - Country:US
Mailing Address - Phone:216-217-0561
Mailing Address - Fax:216-848-1202
Practice Address - Street 1:3618 RAYMONT BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2617
Practice Address - Country:US
Practice Address - Phone:216-217-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1816075103K00000X, 225CA2400X, 225CA2500X
OHSP8177231HA2400X
OHOH1213349251300000X
OH36D2045034291U00000X
347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology PractitionerGroup - Single Specialty
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology SupplierGroup - Single Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
No251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No347B00000XTransportation ServicesBusGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3123882Medicaid