Provider Demographics
NPI:1720775059
Name:ST VOLTAIRE INC
Entity type:Organization
Organization Name:ST VOLTAIRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAVAR
Authorized Official - Middle Name:DEON
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:513-975-9216
Mailing Address - Street 1:489 DEWDROP CIR APT C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3799
Mailing Address - Country:US
Mailing Address - Phone:513-975-9216
Mailing Address - Fax:
Practice Address - Street 1:489 DEWDROP CIR APT C
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3799
Practice Address - Country:US
Practice Address - Phone:513-975-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty