Individual
TAMMY MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
855 GEARHARDT LN, TROY, OH 45373-8620
(937) 606-1153
Mailing address
855 GEARHARDT LN, TROY, OH 45373-8620
(937) 606-1153
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0359085
—
OH
Enumeration date
11/21/2020
Last updated
11/21/2020
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