Healthcare Provider Details

I. General information

NPI: 1639098411
Provider Name (Legal Business Name): AMAYA MARCUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 OHIO STATE ROUTE 28
MILFORD OH
45150
US

IV. Provider business mailing address

703 OHIO STATE ROUTE 28
MILFORD OH
45150
US

V. Phone/Fax

Practice location:
  • Phone: 513-587-8899
  • Fax: 513-815-4386
Mailing address:
  • Phone: 513-587-8899
  • Fax: 513-815-4386

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: