Provider Demographics
NPI:1245600329
Name:MAURICE, BILLIE
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:MAURICE
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 1:4655 KISER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072-9338
Mailing Address - Country:US
Mailing Address - Phone:937-726-5823
Mailing Address - Fax:
Practice Address - Street 1:4655 KISER LAKE RD
Practice Address - Street 2:
Practice Address - City:SAINT PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072-9338
Practice Address - Country:US
Practice Address - Phone:937-726-5823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 6147174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist