Healthcare Provider Details

I. General information

NPI: 1578217980
Provider Name (Legal Business Name): TARA D CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2022
Last Update Date: 02/05/2022
Certification Date: 02/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 GROVE RUN RD
COMMERCIAL POINT OH
43116-9707
US

IV. Provider business mailing address

133 GROVE RUN RD
COMMERCIAL POINT OH
43116-9707
US

V. Phone/Fax

Practice location:
  • Phone: 614-565-9151
  • Fax:
Mailing address:
  • Phone: 614-565-9151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: