MEDICARE: CHRISTOPHER ENZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	21679522	OH

General Provider Information

NPI Number	:	1083220982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ENZ

Provider Business Mailing Address
First Line	:	914 MOHAWK DR
Second Line	:
City	:	MC DERMOTT
State	:	OH
Zip	:	45652-9000
Country	:	US
Telephone Number	:	740-259-5558
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 MOHAWK DR
Second Line	:
City	:	MC DERMOTT
State	:	OH
Zip	:	45652-9000
Country	:	US
Telephone Number	:	740-259-5558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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