MEDICARE: DOUGLAS BRADY METZ

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	SP.00663	OH

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	:	1245904606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS BRADY METZ

Provider Business Mailing Address
First Line	:	436 LIBERTY HL # 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-0964
Country	:	US
Telephone Number	:	513-312-7103
Fax Number	:

Provider Business Practice Location Address
First Line	:	11085 MONTGOMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-2394
Country	:	US
Telephone Number	:	513-312-7103
Fax Number	:

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

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	08/09/2021

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