Provider Demographics
NPI:1275131781
Name:OFORI, JULIET
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:OFORI
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 1:2985 AMBARWENT RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7058
Mailing Address - Country:US
Mailing Address - Phone:614-302-8318
Mailing Address - Fax:
Practice Address - Street 1:2985 AMBARWENT RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7058
Practice Address - Country:US
Practice Address - Phone:614-302-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2573300374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0321255Medicaid
OH2573300OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES