MEDICARE: DONNA MARIA CAROTHERS

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	172A00000X	Driver	172A00000X	OH
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	385HR2060X	OH
3	376J00000X	Homemaker	3747P1801X	OH
4	376J00000X	Homemaker	376J00000X	OH

General Provider Information

NPI Number	:	1487436994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA MARIA CAROTHERS

Provider Business Mailing Address
First Line	:	3965 PARLIAMENT PL APT 95
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-4334
Country	:	US
Telephone Number	:	937-301-5493
Fax Number	:

Provider Business Practice Location Address
First Line	:	3965 PARLIAMENT PL APT 95
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-4334
Country	:	US
Telephone Number	:	937-301-5493
Fax Number	:

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

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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Directions to “ DONNA MARIA CAROTHERS ” Practice Location

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