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General NPI Number Information
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NPI Number | 1992695787
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Entity Type | Individual
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Provider Name | BOSTON ELIJAH REISINGER
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Gender | Male
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 639 ONEIDA RD
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-1228
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Country | US
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Telephone | 740-542-2584
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Fax |
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Provider Business Mailing Address
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Address Line | 639 ONEIDA RD
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City | CHILLICOTHEE
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State | OH
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Zip | 45601-1228
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Country | US
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Telephone | 740-542-2584
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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 | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State | OH
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