Healthcare Provider Details

I. General information

NPI: 1457150773
Provider Name (Legal Business Name): MARY M OPLIGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 HARRISON RD
FREDERICKSBURG OH
44627-9529
US

IV. Provider business mailing address

3851 HARRISON RD
FREDERICKSBURG OH
44627-9529
US

V. Phone/Fax

Practice location:
  • Phone: 330-401-7579
  • Fax:
Mailing address:
  • Phone: 330-401-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: