=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023615101
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI J SHERROD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2020
-----------------------------------------------------
Last Update Date | 10/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 US HIGHWAY 50
-----------------------------------------------------
City | MARATHON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45118-8605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-661-0445
-----------------------------------------------------
Fax | 937-466-0023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 US HIGHWAY 50
-----------------------------------------------------
City | MARATHON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45118-8605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-661-0445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number | 0801607
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------