MEDICARE: MRS. MARIA TERESA CARR CPRS

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	175T00000X	Peer Specialist	APS.004407	OH

General Provider Information

NPI Number	:	1922872639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA TERESA CARR CPRS

Provider Business Mailing Address
First Line	:	6026 RED OAK DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1855
Country	:	US
Telephone Number	:	419-936-8711
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 W CENTRAL AVE STE 118
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1421
Country	:	US
Telephone Number	:	419-469-2529
Fax Number	:

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

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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