Healthcare Provider Details

I. General information

NPI: 1912827718
Provider Name (Legal Business Name): MISS IRELAND MAKENNA FAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 KOOP RD
LIMA OH
45807-2249
US

IV. Provider business mailing address

2960 KOOP RD
LIMA OH
45807-2249
US

V. Phone/Fax

Practice location:
  • Phone: 567-825-1127
  • Fax:
Mailing address:
  • Phone: 567-825-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: