Healthcare Provider Details

I. General information

NPI: 1538919329
Provider Name (Legal Business Name): MARIAH LARELL ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 COOLEY LN # 2205
HUBER HEIGHTS OH
45424-3285
US

IV. Provider business mailing address

4050 EMBER DR UNIT 216
TIPP CITY OH
45371-7650
US

V. Phone/Fax

Practice location:
  • Phone: 937-409-1309
  • Fax:
Mailing address:
  • Phone: 937-409-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: