Provider Demographics
NPI:1043971260
Name:STROTHER, DERRIK A I
Entity Type:Individual
Prefix:
First Name:DERRIK
Middle Name:A
Last Name:STROTHER
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 FULBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-1826
Mailing Address - Country:US
Mailing Address - Phone:151-381-5704
Mailing Address - Fax:
Practice Address - Street 1:2457 FULBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1826
Practice Address - Country:US
Practice Address - Phone:151-381-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities