Healthcare Provider Details

I. General information

NPI: 1700375573
Provider Name (Legal Business Name): DONALD ENTLER PRS, CMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 CAREYS RUN RD
MC DERMOTT OH
45652-3902
US

IV. Provider business mailing address

118 E 2ND ST UNIT 7
WAVERLY OH
45690-1361
US

V. Phone/Fax

Practice location:
  • Phone: 740-858-6683
  • Fax:
Mailing address:
  • Phone: 220-286-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: