Provider Demographics
NPI:1356806756
Name:VASILEVICH, BRITNI
Entity type:Individual
Prefix:
First Name:BRITNI
Middle Name:
Last Name:VASILEVICH
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 1:17590 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:44429-9762
Mailing Address - Country:US
Mailing Address - Phone:440-813-7007
Mailing Address - Fax:
Practice Address - Street 1:6831 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-297-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA006857224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant