Provider Demographics
NPI:1518554179
Name:TEEPLE, JOSIAH DANIEL
Entity Type:Individual
Prefix:
First Name:JOSIAH
Middle Name:DANIEL
Last Name:TEEPLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1713
Mailing Address - Country:US
Mailing Address - Phone:515-657-3138
Mailing Address - Fax:
Practice Address - Street 1:135 TIMBERWIND LN
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9763
Practice Address - Country:US
Practice Address - Phone:515-657-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child