=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023824299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE NACOLE FOLTIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2024
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HALLORAN PARK LN
-----------------------------------------------------
City | SAINT CLAIRSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43950-1367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-296-5743
-----------------------------------------------------
Fax | 740-296-5952
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3331 WASHINGTON ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43906-1666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-391-0818
-----------------------------------------------------
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 |
-----------------------------------------------------