Provider Demographics
NPI:1275751901
Name:KING, ETHEL MARIE
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ETHEL
Other - Middle Name:
Other - Last Name:TUMBLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 BIG RUN RD
Mailing Address - Street 2:
Mailing Address - City:OTWAY
Mailing Address - State:OH
Mailing Address - Zip Code:95657
Mailing Address - Country:US
Mailing Address - Phone:740-372-5811
Mailing Address - Fax:
Practice Address - Street 1:11840 US 52
Practice Address - Street 2:
Practice Address - City:STOUT
Practice Address - State:OH
Practice Address - Zip Code:45684
Practice Address - Country:US
Practice Address - Phone:740-858-4868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide