Provider Demographics
NPI:1164048518
Name:STUART, MARIAH ELLEN
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:ELLEN
Last Name:STUART
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 1:814 RIDGEWOOD DR # 2
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9814
Mailing Address - Country:US
Mailing Address - Phone:509-481-0751
Mailing Address - Fax:
Practice Address - Street 1:101 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1516
Practice Address - Country:US
Practice Address - Phone:859-985-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer