Provider Demographics
NPI:1154065811
Name:DICK, MARY A
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:DICK
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 1:15190 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-8930
Mailing Address - Country:US
Mailing Address - Phone:614-771-9161
Mailing Address - Fax:
Practice Address - Street 1:15190 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-8930
Practice Address - Country:US
Practice Address - Phone:614-771-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services