Provider Demographics
NPI:1346466976
Name:ENDICOTT, TRISHA L
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:L
Last Name:ENDICOTT
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 1:11999 STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9707
Mailing Address - Country:US
Mailing Address - Phone:330-424-4737
Mailing Address - Fax:
Practice Address - Street 1:11999 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9707
Practice Address - Country:US
Practice Address - Phone:330-424-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2104234171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH107085842699Medicaid
OH171027384601Medicaid