Provider Demographics
NPI:1760776785
Name:PORTER, NATIATA SARUDZAI
Entity Type:Individual
Prefix:MS
First Name:NATIATA
Middle Name:SARUDZAI
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 DEEPWOOD BLVD
Mailing Address - Street 2:APT 16G
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8901
Mailing Address - Country:US
Mailing Address - Phone:440-525-6820
Mailing Address - Fax:
Practice Address - Street 1:8050 DEEPWOOD BLVD
Practice Address - Street 2:APT 16G
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8901
Practice Address - Country:US
Practice Address - Phone:440-525-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04487224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant