MEDICARE: HARLEY GREGORY

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	171WH0202X	Home Modifications Contractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154730356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARLEY GREGORY

Provider Business Mailing Address
First Line	:	109 PROSPECT ST
Second Line	:
City	:	NORTH FAIRFIELD
State	:	OH
Zip	:	44855-9550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 PROSPECT ST
Second Line	:
City	:	NORTH FAIRFIELD
State	:	OH
Zip	:	44855-9550
Country	:	US
Telephone Number	:	419-577-7896
Fax Number	:

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

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	08/13/2014

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Directions to “ HARLEY GREGORY ” Practice Location

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