Provider Demographics
NPI:1043016348
Name:PORTER, MALIA R
Entity type:Individual
Prefix:MS
First Name:MALIA
Middle Name:R
Last Name:PORTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37045 SCOUT RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-9167
Mailing Address - Country:US
Mailing Address - Phone:740-279-8151
Mailing Address - Fax:
Practice Address - Street 1:37045 SCOUT RD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9167
Practice Address - Country:US
Practice Address - Phone:740-279-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health