MEDICARE: MRS. MARY OJO

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	251B00000X	Case Management Agency	18783	TX

General Provider Information

NPI Number	:	1588984934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY OJO

Provider Business Mailing Address
First Line	:	1924 FOXWOOD DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4779
Country	:	US
Telephone Number	:	800-239-0371
Fax Number	:	866-611-2758

Provider Business Practice Location Address
First Line	:	1924 FOXWOOD DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4779
Country	:	US
Telephone Number	:	800-239-0371
Fax Number	:	866-611-2758

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	07/26/2010

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