Provider Demographics
NPI:1003458118
Name:TEAFORD, CECILIA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARIE
Last Name:TEAFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:MARIE
Other - Last Name:CORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:990 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:990 2ND AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1637
Practice Address - Country:US
Practice Address - Phone:740-441-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018845225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist