Provider Demographics
NPI:1598516395
Name:GIFFORD, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:GIFFORD
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 1:86231 BAKERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JEWETT
Mailing Address - State:OH
Mailing Address - Zip Code:43986-9500
Mailing Address - Country:US
Mailing Address - Phone:740-461-0094
Mailing Address - Fax:
Practice Address - Street 1:86231 BAKERS RIDGE RD
Practice Address - Street 2:
Practice Address - City:JEWETT
Practice Address - State:OH
Practice Address - Zip Code:43986-9500
Practice Address - Country:US
Practice Address - Phone:740-945-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant