Healthcare Provider Details

I. General information

NPI: 1053795872
Provider Name (Legal Business Name): DARBY THELMA MOLONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 GREENFIELD ST
TIFFIN OH
44883-2445
US

IV. Provider business mailing address

9966 KERR CEMETERY RD
LOVELAND OH
45140-7803
US

V. Phone/Fax

Practice location:
  • Phone: 513-706-0252
  • Fax:
Mailing address:
  • Phone: 513-706-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: