Healthcare Provider Details

I. General information

NPI: 1255941399
Provider Name (Legal Business Name): MS. STEPHLYNN MIA COATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 AZALEA DR
DAYTON OH
45417-9308
US

IV. Provider business mailing address

1601 AZALEA DR
DAYTON OH
45417-9308
US

V. Phone/Fax

Practice location:
  • Phone: 937-344-6748
  • Fax:
Mailing address:
  • Phone: 937-344-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: