MEDICARE: CAROL J THEOBALD

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	253Z00000X	In Home Supportive Care Agency		OH

General Provider Information

NPI Number	:	1578424164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL J THEOBALD

Provider Business Mailing Address
First Line	:	3198 RIVER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45204-1270
Country	:	US
Telephone Number	:	513-200-4563
Fax Number	:

Provider Business Practice Location Address
First Line	:	3198 RIVER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45204-1270
Country	:	US
Telephone Number	:	513-200-4563
Fax Number	:

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

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	11/21/2025

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Directions to “ CAROL J THEOBALD ” Practice Location

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