Provider Demographics
NPI:1851904619
Name:GOLT, TWILA MICHELLE
Entity Type:Individual
Prefix:
First Name:TWILA
Middle Name:MICHELLE
Last Name:GOLT
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 1:7649 FORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIO
Mailing Address - State:WV
Mailing Address - Zip Code:26755-6413
Mailing Address - Country:US
Mailing Address - Phone:304-359-4404
Mailing Address - Fax:
Practice Address - Street 1:7649 FORD HILL RD
Practice Address - Street 2:
Practice Address - City:RIO
Practice Address - State:WV
Practice Address - Zip Code:26755-6413
Practice Address - Country:US
Practice Address - Phone:304-359-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant