Individual
TINA L. SOUKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
6451 CENTER ST, MENTOR, OH 44060-4109
(440) 255-4444
Mailing address
6451 CENTER ST, MENTOR, OH 44060-4109
(440) 255-4444
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-4850
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0747777
—
OH
Enumeration date
06/23/2010
Last updated
05/02/2014
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