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Individual

MARY V BYRD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
37 STERLING RD, MARIETTA, OH 45750
(740) 516-4496
Mailing address
PO BOX 283, RENO, OH 45773-0283

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
8401723
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000240269
SUPPLIER ID
OH
05
0179528
OH
Enumeration date
10/15/2020
Last updated
10/15/2020
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