Provider Demographics
NPI:1689143919
Name:CARTAINO, MARY MONICA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MONICA
Last Name:CARTAINO
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 1:2200 O REILLY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45118-9290
Mailing Address - Country:US
Mailing Address - Phone:513-875-2739
Mailing Address - Fax:
Practice Address - Street 1:6200 PFEIFFER RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-5862
Practice Address - Country:US
Practice Address - Phone:513-985-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.023927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist