Healthcare Provider Details

I. General information

NPI: 1619893591
Provider Name (Legal Business Name): TERI L BEVINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 TRACIE LN
WEST MILTON OH
45383-1387
US

IV. Provider business mailing address

103 TRACIE LN
WEST MILTON OH
45383-1387
US

V. Phone/Fax

Practice location:
  • Phone: 937-573-6629
  • Fax:
Mailing address:
  • Phone: 937-573-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: