Healthcare Provider Details

I. General information

NPI: 1982286225
Provider Name (Legal Business Name): TERRIAN CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 S 3RD ST
IRONTON OH
45638-2269
US

IV. Provider business mailing address

1724 S 3RD ST
IRONTON OH
45638-2269
US

V. Phone/Fax

Practice location:
  • Phone: 740-479-5135
  • Fax: 740-237-4870
Mailing address:
  • Phone: 740-479-5135
  • Fax: 740-237-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: