Individual
EBONEE ROSE BLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4604 GILMAN RD, COLUMBUS, OH 43228-6471
(614) 371-2645
Mailing address
4604 GILMAN RD, COLUMBUS, OH 43228-6471
(614) 371-2645
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
VQ610186
OH
3747P1801X
Personal Care Attendant
Primary
—
OH
376J00000X
Homemaker
—
OH
Other
Enumeration date
12/04/2025
Last updated
12/04/2025
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