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General NPI Number Information
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NPI Number | 1508588716
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Entity Type | Individual
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Provider Name | MARISSA WITT
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Gender | Female
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 411 WESTERN ROW RD
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City | MASON
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State | OH
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Zip | 45040-1438
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Country | US
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Telephone | 513-398-1486
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Fax |
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Provider Business Mailing Address
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Address Line | 6692 RAES CREEK CT
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City | LOVELAND
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State | OH
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Zip | 45140-8395
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Country | US
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Telephone | 513-503-1728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 1134548829
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | COND.20222214-SP
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License Number State | OH
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