Provider Demographics
NPI:1831319029
Name:ROBERTS, THERESA MARIE (AUDIOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51A S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2361
Mailing Address - Country:US
Mailing Address - Phone:937-433-8080
Mailing Address - Fax:937-433-9554
Practice Address - Street 1:51A S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45458-2361
Practice Address - Country:US
Practice Address - Phone:937-433-8080
Practice Address - Fax:937-433-9554
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01082237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000286865OtherANTHEM PROVIDER NUMBER
OH000000286865OtherANTHEM PROVIDER NUMBER