Provider Demographics
NPI:1104985282
Name:TOLER, MIA YI
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:YI
Last Name:TOLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MIA
Other - Middle Name:YI
Other - Last Name:SAXOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:321 PRETTY LAKE HTS
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9722
Mailing Address - Country:US
Mailing Address - Phone:740-466-3773
Mailing Address - Fax:
Practice Address - Street 1:7908 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49024
Practice Address - Country:US
Practice Address - Phone:269-323-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2470384Medicaid