Healthcare Provider Details

I. General information

NPI: 1619470812
Provider Name (Legal Business Name): GRETCHEN MARYE MAY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 COMMERCE CENTER BLVD
FAIRBORN OH
45324-6333
US

IV. Provider business mailing address

1750 COMMERCE CENTER BLVD
FAIRBORN OH
45324-6333
US

V. Phone/Fax

Practice location:
  • Phone: 937-878-8444
  • Fax: 937-878-6266
Mailing address:
  • Phone: 937-878-8444
  • Fax: 937-878-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT16-13589
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: