Healthcare Provider Details

I. General information

NPI: 1639839707
Provider Name (Legal Business Name): MARY EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 05/11/2026
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 HILLWOOD DR
KETTERING OH
45439-2523
US

IV. Provider business mailing address

1633 HILLWOOD DR
KETTERING OH
45439-2523
US

V. Phone/Fax

Practice location:
  • Phone: 937-266-8755
  • Fax:
Mailing address:
  • Phone: 937-266-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP.10780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: