Provider Demographics
NPI:1184846560
Name:THOMPSON, SYLVIA
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:
Last Name:THOMPSON
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 333
Mailing Address - Street 2:1525 N TWP RD 77
Mailing Address - City:REPUBLIC
Mailing Address - State:OH
Mailing Address - Zip Code:44867
Mailing Address - Country:US
Mailing Address - Phone:419-585-7017
Mailing Address - Fax:
Practice Address - Street 1:6627 S BLOOM TWP RD 173
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:OH
Practice Address - Zip Code:44818
Practice Address - Country:US
Practice Address - Phone:419-983-5084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143246Medicaid
OH2143246Medicare ID - Type Unspecified