Provider Demographics
NPI:1700051828
Name:CHILDRESS, ORA L
Entity Type:Individual
Prefix:
First Name:ORA
Middle Name:L
Last Name:CHILDRESS
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 1:2001 OLD SAINT AUGUSTINE RD APT B204
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-0930
Mailing Address - Country:US
Mailing Address - Phone:850-402-9094
Mailing Address - Fax:
Practice Address - Street 1:2001 OLD SAINT AUGUSTINE RD APT B204
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-0930
Practice Address - Country:US
Practice Address - Phone:850-402-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide