=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558171702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRY J CONLIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2025
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6989 DUTCHLAND BLVD
-----------------------------------------------------
City | LIBERTY TOWNSHIP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45044-9021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-417-4813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 WILLIAMS AVE
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45015-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-417-4813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------