Healthcare Provider Details

I. General information

NPI: 1225828676
Provider Name (Legal Business Name): MARINA BALLATIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 RALSTON AVE STE 302
DEFIANCE OH
43512-1480
US

IV. Provider business mailing address

1252 RALSTON AVE STE 302
DEFIANCE OH
43512-1480
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-6996
  • Fax: 419-782-8062
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010143RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: