Healthcare Provider Details

I. General information

NPI: 1770400442
Provider Name (Legal Business Name): AMBER GAYLE WOLFROM OCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S MAIN ST
LIMA OH
45804-1500
US

IV. Provider business mailing address

530 S MAIN ST
LIMA OH
45804-1500
US

V. Phone/Fax

Practice location:
  • Phone: 419-425-5050
  • Fax:
Mailing address:
  • Phone: 419-425-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: