Provider Demographics
NPI:1083486831
Name:OSBORNE, TERRA LEA
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:LEA
Last Name:OSBORNE
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:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:FOSTER
Mailing Address - State:WV
Mailing Address - Zip Code:25081-0180
Mailing Address - Country:US
Mailing Address - Phone:304-542-4403
Mailing Address - Fax:
Practice Address - Street 1:285 MARIGOLD LANE
Practice Address - Street 2:
Practice Address - City:PEYTONA
Practice Address - State:WV
Practice Address - Zip Code:25154
Practice Address - Country:US
Practice Address - Phone:304-542-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant