Provider Demographics
NPI:1043431000
Name:BIRCHLER, BOBBI JANE
Entity Type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:JANE
Last Name:BIRCHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BENDER ST NE
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-8541
Mailing Address - Country:US
Mailing Address - Phone:330-879-5675
Mailing Address - Fax:
Practice Address - Street 1:485 CARVER ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-5309
Practice Address - Country:US
Practice Address - Phone:330-837-7765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2715931171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2715931Medicaid