=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023592201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATISHA JANELLE GREATHOUSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2018
-----------------------------------------------------
Last Update Date | 09/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HALLORAN PARK LANE
-----------------------------------------------------
City | ST CLAIRSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-296-5743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39985 GUN CLUB RD
-----------------------------------------------------
City | WOODSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43793-9054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-213-3832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------