Healthcare Provider Details

I. General information

NPI: 1992511463
Provider Name (Legal Business Name): THERESA FYOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W STATE ST
NEWCOMERSTOWN OH
43832-1325
US

IV. Provider business mailing address

640 W STATE ST
NEWCOMERSTOWN OH
43832-1325
US

V. Phone/Fax

Practice location:
  • Phone: 330-401-7469
  • Fax:
Mailing address:
  • Phone: 330-401-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: