=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396698767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESA LYNN SANDERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2026
-----------------------------------------------------
Last Update Date | 02/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2329 PARK RIDGE DR
-----------------------------------------------------
City | GROVE CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43123-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-743-9059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2329 PARK RIDGE DR
-----------------------------------------------------
City | GROVE CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43123-1819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-743-9059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number | 376.1000000X
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------