Healthcare Provider Details

I. General information

NPI: 1083216972
Provider Name (Legal Business Name): ROBERT S MCINTOSH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 11/15/2020
Certification Date: 11/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 SILVERCLIFF DR
DAYTON OH
45449-3364
US

IV. Provider business mailing address

2891 SILVERCLIFF DR
DAYTON OH
45449-3364
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-0789
  • Fax:
Mailing address:
  • Phone: 513-354-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: