Healthcare Provider Details

I. General information

NPI: 1831419274
Provider Name (Legal Business Name): MARYJANE GARAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 DALE AVE NW
STRASBURG OH
44680-1064
US

IV. Provider business mailing address

156 DALE AVE NW
STRASBURG OH
44680-1064
US

V. Phone/Fax

Practice location:
  • Phone: 330-432-6009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number02897
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: