Provider Demographics
NPI:1568462000
Name:FULTON COUNTY BOARD OF DD
Entity Type:Organization
Organization Name:FULTON COUNTY BOARD OF DD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-337-4575
Mailing Address - Street 1:1210 N OTTOKEE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1906
Mailing Address - Country:US
Mailing Address - Phone:419-337-4575
Mailing Address - Fax:419-335-3082
Practice Address - Street 1:1210 N OTTOKEE ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1906
Practice Address - Country:US
Practice Address - Phone:419-337-4575
Practice Address - Fax:419-335-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2600019251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776085Medicaid