Provider Demographics
NPI:1750857256
Name:OBRYNBA, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:OBRYNBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8602
Mailing Address - Country:US
Mailing Address - Phone:513-695-2900
Mailing Address - Fax:
Practice Address - Street 1:97 ASTRO WAY
Practice Address - Street 2:
Practice Address - City:SABINA
Practice Address - State:OH
Practice Address - Zip Code:45169-9521
Practice Address - Country:US
Practice Address - Phone:937-584-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOND2018902-SPMedicaid