=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609058213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENEE R CHOICE, MD INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2007
-----------------------------------------------------
Last Update Date | 12/05/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4455 STATE ROUTE 159
-----------------------------------------------------
City | CHILLICOTHEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45601-8620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-702-7110
-----------------------------------------------------
Fax | 740-702-7111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4455 STATE ROUTE 159
-----------------------------------------------------
City | CHILLICOTHEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45601-8620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-702-7110
-----------------------------------------------------
Fax | 740-702-7111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DENEE R CHOICE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 740-702-7110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 35069449
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------