Healthcare Provider Details

I. General information

NPI: 1407101801
Provider Name (Legal Business Name): MARY ELISE WARE PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2012
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 S FRONT ST
COLUMBUS OH
43206-1905
US

IV. Provider business mailing address

761 S FRONT ST
COLUMBUS OH
43206-1905
US

V. Phone/Fax

Practice location:
  • Phone: 614-563-2810
  • Fax:
Mailing address:
  • Phone: 614-563-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1100290
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.013669
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: