Provider Demographics
NPI:1033870167
Name:FOUT, RAE MARLENE
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:MARLENE
Last Name:FOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36993 STATE ROUTE 327
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:OH
Mailing Address - Zip Code:45672-9662
Mailing Address - Country:US
Mailing Address - Phone:740-993-9738
Mailing Address - Fax:
Practice Address - Street 1:36993 STATE ROUTE 327
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:OH
Practice Address - Zip Code:45672-9662
Practice Address - Country:US
Practice Address - Phone:740-993-9738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant