Provider Demographics
NPI:1225638976
Name:HIGHLEY, ROGER DALE
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DALE
Last Name:HIGHLEY
Suffix:
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:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:GRATIS
Mailing Address - State:OH
Mailing Address - Zip Code:45330-0060
Mailing Address - Country:US
Mailing Address - Phone:937-287-4240
Mailing Address - Fax:
Practice Address - Street 1:404 S ADA DOTY ST
Practice Address - Street 2:
Practice Address - City:GRATIS
Practice Address - State:OH
Practice Address - Zip Code:45330
Practice Address - Country:US
Practice Address - Phone:937-287-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide