1740394410 NPI number — MICHELLE MARIE GARBER LICDC

Table of content: MICHELLE MARIE GARBER LICDC (NPI 1740394410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740394410 NPI number — MICHELLE MARIE GARBER LICDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARBER
Provider First Name:
MICHELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740394410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
12/16/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 765
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCYRUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-562-2000
Provider Business Mailing Address Fax Number:
419-562-1296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2458 STETZER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCYRUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-562-2000
Provider Business Practice Location Address Fax Number:
419-562-1296
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  933750 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)