Healthcare Provider Details

I. General information

NPI: 1184846560
Provider Name (Legal Business Name): MRS. SYLVIA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6627 S BLOOM TWP RD 173
BLOOMVILLE OH
44818
US

IV. Provider business mailing address

PO BOX 333 1525 N TWP RD 77
REPUBLIC OH
44867
US

V. Phone/Fax

Practice location:
  • Phone: 419-983-5084
  • Fax:
Mailing address:
  • Phone: 419-585-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: