Individual
LAQUETA R MAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1209 OAKHILL AVE, FAIRBORN, OH 45324-5636
(937) 212-3529
Mailing address
1209 OAKHILL AVE, FAIRBORN, OH 45324-5636
(937) 212-3529
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
APS005305
OH
175T00000X
Peer Specialist
Primary
APS005305
—
Other
Enumeration date
08/08/2024
Last updated
08/08/2024
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