Healthcare Provider Details

I. General information

NPI: 1962348540
Provider Name (Legal Business Name): MARY PETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 DIAGONAL RD
AKRON OH
44320-4030
US

IV. Provider business mailing address

1466 DIAGONAL RD
AKRON OH
44320-4030
US

V. Phone/Fax

Practice location:
  • Phone: 330-328-9167
  • Fax:
Mailing address:
  • Phone: 330-328-9167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: