Healthcare Provider Details

I. General information

NPI: 1760950505
Provider Name (Legal Business Name): GAYLE COLLINS IP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 N MAIN ST
DAYTON OH
45415-1331
US

IV. Provider business mailing address

8717 N MAIN ST
DAYTON OH
45415-1331
US

V. Phone/Fax

Practice location:
  • Phone: 937-371-9941
  • Fax: 937-387-6085
Mailing address:
  • Phone: 937-371-9941
  • Fax: 937-387-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: