Healthcare Provider Details

I. General information

NPI: 1184753410
Provider Name (Legal Business Name): MELANIE RENEE HOTTINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N 11TH ST
NEWARK OH
43055-4417
US

IV. Provider business mailing address

233 N 11TH ST
NEWARK OH
43055-4417
US

V. Phone/Fax

Practice location:
  • Phone: 740-349-5875
  • Fax:
Mailing address:
  • Phone: 740-349-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2662453
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: