MEDICARE: MICHELLE ELIZABETH MAYLE

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	376J00000X	Homemaker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7601741	OTHER	OH	PROVIDER NUMBER

General Provider Information

NPI Number	:	1578502712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ELIZABETH MAYLE

Provider Business Mailing Address
First Line	:	11088 DOLPHIN ST SW
Second Line	:
City	:	BEACH CITY
State	:	OH
Zip	:	44608-9762
Country	:	US
Telephone Number	:	330-756-0845
Fax Number	:	330-756-0845

Provider Business Practice Location Address
First Line	:	11088 DOLPHIN ST SW
Second Line	:
City	:	BEACH CITY
State	:	OH
Zip	:	44608-9762
Country	:	US
Telephone Number	:	330-756-0845
Fax Number	:	330-756-0845

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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Directions to “ MICHELLE ELIZABETH MAYLE ” Practice Location

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