Healthcare Provider Details

I. General information

NPI: 1538099791
Provider Name (Legal Business Name): MAKALAH GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 FORD ROAD NORTH LOT 35
MANSFIELD OH
44905
US

IV. Provider business mailing address

76 FORD ROAD NORTH LOT 35
MANSFIELD OH
44905
US

V. Phone/Fax

Practice location:
  • Phone: 419-632-5661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: