Provider Demographics
NPI:1760141303
Name:REAVES, MARIAH FAYE
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:FAYE
Last Name:REAVES
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 1:2628 LAKESIDE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1747
Mailing Address - Country:US
Mailing Address - Phone:330-617-3758
Mailing Address - Fax:
Practice Address - Street 1:2628 LAKESIDE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1747
Practice Address - Country:US
Practice Address - Phone:330-617-3758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide