Individual
MIRANDA BAISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 OREGONIA RD, LEBANON, OH 45036-3903
(614) 357-0299
Mailing address
479N N GALLOWAY ST, XENIA, OH 45385-2344
(614) 357-0299
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/28/2024
Last updated
05/28/2024
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