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General NPI Number Information
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NPI Number | 1770188146
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Entity Type | Individual
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Provider Name | MAILE FAITH MOYER
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Gender | Female
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 5631 PRAIRIE RD
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City | URBANA
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State | OH
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Zip | 43078-9237
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Country | US
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Telephone | 937-622-3045
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Fax |
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Provider Business Mailing Address
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Address Line | 21501 LINGREL RD
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City | WEST MANSFIELD
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State | OH
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Zip | 43358-9613
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Country | US
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Telephone | 937-622-3045
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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