Provider Demographics
NPI:1730826033
Name:FONTES, TORI (MBA)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:FONTES
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WERTZ AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1980
Mailing Address - Country:US
Mailing Address - Phone:330-907-2866
Mailing Address - Fax:
Practice Address - Street 1:915 WERTZ AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1980
Practice Address - Country:US
Practice Address - Phone:330-907-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator