Healthcare Provider Details

I. General information

NPI: 1790402360
Provider Name (Legal Business Name): MAKAYLA SLATER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4256 UPPER FIVE MILE RD
MOUNT ORAB OH
45154-9726
US

IV. Provider business mailing address

2952 HARKER WAITS RD
MOUNT ORAB OH
45154-9559
US

V. Phone/Fax

Practice location:
  • Phone: 937-444-3843
  • Fax:
Mailing address:
  • Phone: 513-518-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: