Healthcare Provider Details

I. General information

NPI: 1184538654
Provider Name (Legal Business Name): ROBERT-EVAN T REEDY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HARRISON ST
GRATIS OH
45330-4528
US

IV. Provider business mailing address

4501 CAMDEN WEST ELKTON RD
SOMERVILLE OH
45064-9450
US

V. Phone/Fax

Practice location:
  • Phone: 937-831-4937
  • Fax:
Mailing address:
  • Phone: 513-773-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number160175
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: