MEDICARE: TARYN OLIVIA MOGA LISW

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	104100000X	Social Worker	I.2304747	OH

General Provider Information

NPI Number	:	1649752528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARYN OLIVIA MOGA LISW

Provider Business Mailing Address
First Line	:	6651 GARDEN RD
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-1278
Country	:	US
Telephone Number	:	419-343-5643
Fax Number	:

Provider Business Practice Location Address
First Line	:	4352 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3463
Country	:	US
Telephone Number	:	419-561-5433
Fax Number	:

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	12/12/2023

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