Healthcare Provider Details

I. General information

NPI: 1740313113
Provider Name (Legal Business Name): PUTNAM COUNTY BOARD OF MENTAL RETARDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7989 STATE ROUTE 108
OTTAWA OH
45875-9678
US

IV. Provider business mailing address

7989 STATE ROUTE 108
OTTAWA OH
45875-9678
US

V. Phone/Fax

Practice location:
  • Phone: 419-876-3944
  • Fax: 419-876-3945
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number0840022
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0840022
License Number StateOH

VIII. Authorized Official

Name: MR. TERRY LEOPOLD
Title or Position: SUPERINTENDENT
Credential:
Phone: 419-876-3944