Healthcare Provider Details

I. General information

NPI: 1922277854
Provider Name (Legal Business Name): DAMON S LITSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1567 CASSINGHAM HOLLOW DR
COSHOCTON OH
43812-9432
US

IV. Provider business mailing address

1567 CASSINGHAM HOLLOW DR
COSHOCTON OH
43812-9432
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-0338
  • Fax:
Mailing address:
  • Phone: 740-622-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2656
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2656
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2656
License Number StateOH

VIII. Authorized Official

Name: MISS KATIE LYNN HOLDERBAUM
Title or Position: OFFICE MANAGER
Credential:
Phone: 740-622-0338