| NPI | 1205233418 |
|---|---|
| Former Name | MARY THERESE REILLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004173RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.004173) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2021-08-16 |