MEDICARE: MISS RYLEIGH RENEE MCMILLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	602384890721	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	215415186871	OTHER	OH	BLS PROVIDER - FISHER TITUS MEDICAL CENTER
2	602384890721	OTHER	OH	STNA - OHIO DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1275264046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RYLEIGH RENEE MCMILLIN

Provider Business Mailing Address
First Line	:	9 SENIOR DR
Second Line	:
City	:	GREENWICH
State	:	OH
Zip	:	44837-1153
Country	:	US
Telephone Number	:	419-681-4777
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 TOWNLINE ROAD 12
Second Line	:
City	:	NORTH FAIRFIELD
State	:	OH
Zip	:	44855-9666
Country	:	US
Telephone Number	:	567-224-2185
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	05/11/2023

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