Provider Demographics
NPI:1265036032
Name:TERRY, LARRY
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:TERRY
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 1:281 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3475
Mailing Address - Country:US
Mailing Address - Phone:304-465-3302
Mailing Address - Fax:304-465-3306
Practice Address - Street 1:281 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3475
Practice Address - Country:US
Practice Address - Phone:304-465-3302
Practice Address - Fax:304-465-3306
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant