Healthcare Provider Details

I. General information

NPI: 1235596669
Provider Name (Legal Business Name): MICHELLE GARBER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE TAYLOR

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S 15TH ST
COSHOCTON OH
43812-2285
US

IV. Provider business mailing address

406 S 15TH ST
COSHOCTON OH
43812-2285
US

V. Phone/Fax

Practice location:
  • Phone: 740-295-3331
  • Fax: 740-295-3332
Mailing address:
  • Phone: 740-295-3331
  • Fax: 740-295-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.004575RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: