Provider Demographics
NPI:1578502712
Name:MAYLE, MICHELLE ELIZABETH
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:MAYLE
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 1:11088 DOLPHIN ST SW
Mailing Address - Street 2:
Mailing Address - City:BEACH CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44608-9762
Mailing Address - Country:US
Mailing Address - Phone:330-756-0845
Mailing Address - Fax:330-756-0845
Practice Address - Street 1:11088 DOLPHIN ST SW
Practice Address - Street 2:
Practice Address - City:BEACH CITY
Practice Address - State:OH
Practice Address - Zip Code:44608-9762
Practice Address - Country:US
Practice Address - Phone:330-756-0845
Practice Address - Fax:330-756-0845
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7601741OtherPROVIDER NUMBER