Healthcare Provider Details

I. General information

NPI: 1346466976
Provider Name (Legal Business Name): MS. TRISHA L ENDICOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11999 STEUBENVILLE PIKE
LISBON OH
44432-9707
US

IV. Provider business mailing address

11999 STEUBENVILLE PIKE
LISBON OH
44432-9707
US

V. Phone/Fax

Practice location:
  • Phone: 330-424-4737
  • Fax:
Mailing address:
  • Phone: 330-424-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2104234
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: