Provider Demographics
NPI:1578686333
Name:OHIO UNIVERSITY
Entity Type:Organization
Organization Name:OHIO UNIVERSITY
Other - Org Name:OHIO UNIVERSITY THERAPY ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALAWISTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,MA ,CCC-SLP
Authorized Official - Phone:740-593-1404
Mailing Address - Street 1:W174 GROVER CENTER
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-593-1404
Mailing Address - Fax:740-593-4433
Practice Address - Street 1:W174 GROVER CENTER
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-1404
Practice Address - Fax:740-593-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 231H00000X
OH235Z00000X
OHA01437237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000246469OtherANTHEM
OH0624471Medicaid
OH9311251Medicare PIN