Healthcare Provider Details

I. General information

NPI: 1740756097
Provider Name (Legal Business Name): MATTHEW SALYERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 COUNTY ROAD 977
PEDRO OH
45659
US

IV. Provider business mailing address

1404 RACE ST
CINCINNATI OH
45202-7297
US

V. Phone/Fax

Practice location:
  • Phone: 740-534-1386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: