Healthcare Provider Details

I. General information

NPI: 1730735952
Provider Name (Legal Business Name): MARYERI GUDZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14191 BRIDLE TRL
STRONGSVILLE OH
44136-8904
US

IV. Provider business mailing address

14191 BRIDLE TRL
STRONGSVILLE OH
44136-8904
US

V. Phone/Fax

Practice location:
  • Phone: 716-969-9380
  • Fax:
Mailing address:
  • Phone: 716-969-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-31298
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: