Individual
MARY JO FARR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1470 WARREN RD, LAKEWOOD, OH 44107-3918
(216) 227-5571
Mailing address
1470 WARREN RD, LAKEWOOD, OH 44107-3918
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT1698
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EIN# 34-6001631
—
OH
Enumeration date
02/28/2014
Last updated
02/28/2014
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