Healthcare Provider Details

I. General information

NPI: 1316856586
Provider Name (Legal Business Name): MARY ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SMITH ST
GREEN SPRINGS OH
44836-9669
US

IV. Provider business mailing address

222 SMITH ST
GREEN SPRINGS OH
44836-9669
US

V. Phone/Fax

Practice location:
  • Phone: 419-307-3575
  • Fax:
Mailing address:
  • Phone: 419-307-3575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License NumberC46850
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: