MEDICARE: MR. STEPHEN WAYNE PERRY JR.

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	372600000X	Adult Companion		OH

General Provider Information

NPI Number	:	1952239923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN WAYNE PERRY JR.

Provider Business Mailing Address
First Line	:	715 KIRK LYNNE ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-3217
Country	:	US
Telephone Number	:	980-987-1401
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 KIRK LYNNE ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-3217
Country	:	US
Telephone Number	:	980-987-1401
Fax Number	:

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

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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