Healthcare Provider Details

I. General information

NPI: 1942036025
Provider Name (Legal Business Name): MRS. TERESA LYN WOODFOLK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19304 BEVERLY AVE
MAPLE HEIGHTS OH
44137-2305
US

IV. Provider business mailing address

19304 BEVERLY AVE
MAPLE HEIGHTS OH
44137-2305
US

V. Phone/Fax

Practice location:
  • Phone: 216-673-1137
  • Fax:
Mailing address:
  • Phone: 216-673-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: