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General NPI Number Information
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NPI Number | 1184583106
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Entity Type | Organization
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Legal Business Name | THE OPEN TABLE CINCY
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 1213 TENNESSEE AVE STE 204
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City | CINCINNATI
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State | OH
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Zip | 45229-1044
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Country | US
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Telephone | 513-900-7619
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Fax |
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Provider Business Mailing Address
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Address Line | 5432 NORTHCREST LN APT 3
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City | CINCINNATI
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State | OH
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Zip | 45247-6415
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MICHAEL ROBERT COLLINS
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Credential | LPCC, LICDC
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Telephone | 513-900-7619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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