Healthcare Provider Details

I. General information

NPI: 1700851797
Provider Name (Legal Business Name): MARY JOHANNA MCGUIRE MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 CRAWFIS BLVD SUITE 210
FAIRLAWN OH
44333-2878
US

IV. Provider business mailing address

50 BAKER BLVD STE 4
FAIRLAWN OH
44333-3635
US

V. Phone/Fax

Practice location:
  • Phone: 330-865-1926
  • Fax:
Mailing address:
  • Phone: 330-865-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT 3324
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: