Provider Demographics
NPI:1467750810
Name:SLAYBAUGH, TERRI LYNN (STNA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:SLAYBAUGH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8665 STATE ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9770
Mailing Address - Country:US
Mailing Address - Phone:937-570-2583
Mailing Address - Fax:
Practice Address - Street 1:8665 STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9770
Practice Address - Country:US
Practice Address - Phone:937-570-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400296181003376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide