Individual
MALLORY MARIE WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ETC
Contact information
Practice address
5914 GLENWAY AVE, CINCINNATI, OH 45238-2009
(513) 478-4169
Mailing address
5914 GLENWAY AVE, CINCINNATI, OH 45238-2009
(513) 478-4169
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
064574
OH
Other
Enumeration date
12/12/2020
Last updated
12/12/2020
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