Provider Demographics
NPI:1376864116
Name:VISLOSKY, HELEN LOUISE (PTA)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:LOUISE
Last Name:VISLOSKY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2635
Mailing Address - Country:US
Mailing Address - Phone:937-903-5966
Mailing Address - Fax:
Practice Address - Street 1:1236 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2635
Practice Address - Country:US
Practice Address - Phone:937-903-5966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012283747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01228OtherSTATE OF OHIO