MEDICARE: DERRIK A STROTHER I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1043971260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRIK A STROTHER I

Provider Business Mailing Address
First Line	:	2457 FULBOURNE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1826
Country	:	US
Telephone Number	:	151-381-5704
Fax Number	:

Provider Business Practice Location Address
First Line	:	2457 FULBOURNE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1826
Country	:	US
Telephone Number	:	151-381-5704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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Directions to “ DERRIK A STROTHER I ” Practice Location

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