Basic Information
| Provider Information | |||||||||
| NPI: | 1932617966 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOTZ | ||||||||
| FirstName: | ROBYN | ||||||||
| MiddleName: | OLIVIA | ||||||||
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| Credential: | CDCAII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6460 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134673774 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6440 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139414999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2018 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 150149 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 0078786 | 05 | OH | MEDICAID |