Healthcare Provider Details

I. General information

NPI: 1265836688
Provider Name (Legal Business Name): MARYANNE RYNO VRABEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9464 US HIGHWAY 36
SAINT PARIS OH
43072-9367
US

IV. Provider business mailing address

738 CLARENDON RD
TROY OH
45373-1114
US

V. Phone/Fax

Practice location:
  • Phone: 937-663-4449
  • Fax:
Mailing address:
  • Phone: 937-335-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOS1034259
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: