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General NPI Number Information
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NPI Number | 1740659077
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Entity Type | Organization
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Legal Business Name | MEGUMI OMONISHI, PH.D. LLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 5100 BRADENTON AVE STE A
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City | DUBLIN
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State | OH
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Zip | 43017-7567
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Country | US
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Telephone | 614-766-5500
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Fax | 614-489-6391
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Provider Business Mailing Address
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Address Line | 5100 BRADENTON AVE STE A
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City | DUBLIN
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State | OH
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Zip | 43017-7567
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Country | US
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Telephone | 614-766-5500
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Fax | 614-489-6391
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MEGUMI OMONISHI
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Credential | PH.D.
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Telephone | 614-766-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6987
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License Number State | OH
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