Healthcare Provider Details

I. General information

NPI: 1104642198
Provider Name (Legal Business Name): TORI RHULE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 W MAIN ST
TIPP CITY OH
45371-2803
US

IV. Provider business mailing address

1483 W MAIN ST
TIPP CITY OH
45371-2803
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-6842
  • Fax:
Mailing address:
  • Phone: 937-548-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2105932
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: