Healthcare Provider Details

I. General information

NPI: 1689594350
Provider Name (Legal Business Name): JUSTICE MARIE RECKNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25212 STATE ROUTE 20
FAYETTE OH
43521-9511
US

IV. Provider business mailing address

511 PERRY ST
DEFIANCE OH
43512-2123
US

V. Phone/Fax

Practice location:
  • Phone: 419-237-3103
  • Fax:
Mailing address:
  • Phone: 419-782-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: