Provider Demographics
NPI:1790995462
Name:TODD, DENISE KAY (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:KAY
Last Name:TODD
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 PARK AVE WEST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1228
Mailing Address - Country:US
Mailing Address - Phone:419-522-4298
Mailing Address - Fax:
Practice Address - Street 1:2249 PARK AVE WEST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1228
Practice Address - Country:US
Practice Address - Phone:419-522-4298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2665610OtherCARESTAR