MEDICARE: BETH A FYFFE M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	347C00000X	Private Vehicle
2	3747P1801X	Personal Care Attendant
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1821760661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH A FYFFE M.ED.

Provider Business Mailing Address
First Line	:	18978 MERCER RD
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-9244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18978 MERCER RD
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-9244
Country	:	US
Telephone Number	:	419-349-8930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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