Provider Demographics
NPI:1467059139
Name:CUSHMAN, DEANA S
Entity Type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:S
Last Name:CUSHMAN
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 1:1801 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-3128
Mailing Address - Country:US
Mailing Address - Phone:740-610-4070
Mailing Address - Fax:
Practice Address - Street 1:1801 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-3128
Practice Address - Country:US
Practice Address - Phone:740-610-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHESE9877347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle