Healthcare Provider Details

I. General information

NPI: 1902720170
Provider Name (Legal Business Name): MALIEA MICHELLE BREEDLOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 US HIGHWAY 250
JEROMESVILLE OH
44840-9672
US

IV. Provider business mailing address

316 US HIGHWAY 250
JEROMESVILLE OH
44840-9672
US

V. Phone/Fax

Practice location:
  • Phone: 330-234-6944
  • Fax:
Mailing address:
  • Phone: 330-234-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: