Healthcare Provider Details

I. General information

NPI: 1336792910
Provider Name (Legal Business Name): ASHLEY MAROLO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N MAIN ST STE 200
SPRINGBORO OH
45066-8005
US

IV. Provider business mailing address

22 N EAST ST UNIT 96
BELLBROOK OH
45305-6004
US

V. Phone/Fax

Practice location:
  • Phone: 248-330-1121
  • Fax: 833-291-4244
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: