# MARY WELLER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477945194
- **Authorized official:** MARY WELLER (RN)
- **Authorized official phone:** (937) 215-8170

## Contact information

- **Practice address:** 3331 WENDOVER ST, SPRINGFIELD, OH 45506-4315
- **Practice address phone:** (931) 215-8170
- **Mailing address:** 3331 WENDOVER ST, SPRINGFIELD, OH 45506-4315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/04/2015
- **Last updated:** 03/04/2015