Provider Demographics
NPI:1093084493
Name:REDMOND, MARY BELLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BELLE
Last Name:REDMOND
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W POE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1219
Mailing Address - Country:US
Mailing Address - Phone:419-352-7558
Mailing Address - Fax:419-354-9501
Practice Address - Street 1:850 W POE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1219
Practice Address - Country:US
Practice Address - Phone:419-352-7558
Practice Address - Fax:419-354-9501
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA02657172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker