Provider Demographics
NPI:1558142612
Name:MADDIX, THERESA ROBIN
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ROBIN
Last Name:MADDIX
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 1:162 SHUMAKER RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-9751
Mailing Address - Country:US
Mailing Address - Phone:740-352-9851
Mailing Address - Fax:
Practice Address - Street 1:162 SHUMAKER RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-9751
Practice Address - Country:US
Practice Address - Phone:740-352-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide