Healthcare Provider Details

I. General information

NPI: 1487436994
Provider Name (Legal Business Name): DONNA MARIA CAROTHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 PARLIAMENT PL APT 95
KETTERING OH
45429-4334
US

IV. Provider business mailing address

3965 PARLIAMENT PL APT 95
KETTERING OH
45429-4334
US

V. Phone/Fax

Practice location:
  • Phone: 937-301-5493
  • Fax:
Mailing address:
  • Phone: 937-301-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number3747P1801X
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number376J00000X
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number385HR2060X
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number172A00000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: