Provider Demographics
NPI:1083371850
Name:COSPY, BERTHA L
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:L
Last Name:COSPY
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 1:317 STUBBS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3160
Mailing Address - Country:US
Mailing Address - Phone:937-815-2735
Mailing Address - Fax:
Practice Address - Street 1:317 STUBBS DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-3160
Practice Address - Country:US
Practice Address - Phone:937-815-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS532660374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty