Provider Demographics
NPI:1588201503
Name:DEAVER, CALEB RICHARD
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:RICHARD
Last Name:DEAVER
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 1:1438 HYGEAN RUN RD
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-8981
Mailing Address - Country:US
Mailing Address - Phone:740-961-5855
Mailing Address - Fax:
Practice Address - Street 1:1870 QUAKER WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2473
Practice Address - Country:US
Practice Address - Phone:740-961-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty