Healthcare Provider Details

I. General information

NPI: 1255608519
Provider Name (Legal Business Name): OHIO UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W174 GROVER CENTER
ATHENS OH
45701
US

IV. Provider business mailing address

W174 GROVER CENTER
ATHENS OH
45701
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-1404
  • Fax: 740-593-4433
Mailing address:
  • Phone: 740-593-1404
  • Fax: 740-593-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberA01437
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberA01437
License Number StateOH

VIII. Authorized Official

Name: DR. MARIANNE S MALAWISTA
Title or Position: COORDINATOR OF CLINICAL SERVICES
Credential: PHD,MA-CCC,SLP
Phone: 740-593-1418