Mary E Derck, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT.002401 Issued in OH

Practice address

2865 N Reynolds Rd
Ste. 110
Toledo, OH 43615-2068

Phone

(419) 578-7530

NPI assigned

Mar 5, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reynolds Road Fitness Center Inc.

  • Specialist
  • Toledo, OH
  • NPI 1780629873
  NPD (past)
• The Toledo Hospital

  • Community/Retail Pharmacy
  • Toledo, OH
  • NPI 1740217678
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104955889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6602 DORR ST APT 202",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436154238",
            "telephone_number": "419-578-7530",
            "fax_number": "419-539-0288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 N REYNOLDS RD",
            "address_2": "STE. 110",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436152068",
            "telephone_number": "419-578-7530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERCK",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT.002401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ebony Depp
• Tamara Depp
• Tiffany Depp, CDCA,QMHS
• Tyrena Depp, CDCA
• Arianna Deppen
• Corvette R Derden
• Kacynthia Derden, STNA
• Raquel Derian
• Armelle Colette Bridgette Deriso, MD
• Marijo Louise Derkin, M.A. CCC/SPL

• Athletic Trainer in Toledo, OH
• Providers in Toledo, OH by specialty
• Athletic Trainer in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.