Healthcare Provider Details

I. General information

NPI: 1841644754
Provider Name (Legal Business Name): MRS. ROCHELLE CLAYTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2016
Last Update Date: 04/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 GREENING RD
TOLEDO OH
43607-3513
US

IV. Provider business mailing address

638 GREENING RD
TOLEDO OH
43607-3513
US

V. Phone/Fax

Practice location:
  • Phone: 419-973-5799
  • Fax:
Mailing address:
  • Phone: 419-973-5799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number171WHO202X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: