Provider Demographics
NPI:1184145229
Name:SPIRTOS, KATIE LAUREN (CAA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LAUREN
Last Name:SPIRTOS
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LAUREN
Other - Last Name:OLENICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:8401 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6725
Practice Address - Country:US
Practice Address - Phone:330-729-2929
Practice Address - Fax:330-286-5396
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000305367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH580233OtherMEDICARE PTAN
14010447OtherCAQH
OH0235107Medicaid