Healthcare Provider Details

I. General information

NPI: 1457161382
Provider Name (Legal Business Name): MRS. RYAN MARIE ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11808 N OHIO ST
DUNNELLON FL
34431-6724
US

IV. Provider business mailing address

6574 SW 166TH TERRACE RD
OCALA FL
34481-5364
US

V. Phone/Fax

Practice location:
  • Phone: 352-462-7021
  • Fax:
Mailing address:
  • Phone: 352-763-0154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25405336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: