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General NPI Number Information
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NPI Number | 1194494070
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Entity Type | Individual
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Provider Name | RANDY COLVIN JR.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 124 CHELTENHAM DR
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City | HEBRON
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State | OH
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Zip | 43025-9047
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Country | US
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Telephone | 614-738-5790
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Fax |
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Provider Business Mailing Address
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Address Line | 5667 YORK RD SW
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City | PATASKALA
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State | OH
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Zip | 43062-7423
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 4032409
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License Number State | OH
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