Individual
DEREK ENGLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1012 MAVOR ST, SPRINGFIELD, OH 45505-2848
(937) 360-7642
Mailing address
1012 MAVOR ST, SPRINGFIELD, OH 45505-2848
(937) 360-7642
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
1204486
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0208810
—
OH
01
—
1204486
DODD CONTRACT NUMBER
OH
Enumeration date
03/09/2017
Last updated
03/09/2017
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