Provider Demographics
NPI:1558785097
Name:INDEPENDENCE HOME THERAPY
Entity Type:Organization
Organization Name:INDEPENDENCE HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:OTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-706-0686
Mailing Address - Street 1:5760 EVANS FARM DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8542
Mailing Address - Country:US
Mailing Address - Phone:740-706-0686
Mailing Address - Fax:855-321-1683
Practice Address - Street 1:5760 EVANS FARM DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8542
Practice Address - Country:US
Practice Address - Phone:740-706-0686
Practice Address - Fax:855-321-1683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2022-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health