MEDICARE: MARY A. DICK

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1154065811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY A. DICK

Provider Business Mailing Address
First Line	:	15190 ROBINSON RD
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-8930
Country	:	US
Telephone Number	:	614-771-9161
Fax Number	:

Provider Business Practice Location Address
First Line	:	15190 ROBINSON RD
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-8930
Country	:	US
Telephone Number	:	614-771-9161
Fax Number	:

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

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	04/27/2022

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