Provider Demographics
NPI:1902395635
Name:WOODFIELD, MILES THOMAS (BS)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:THOMAS
Last Name:WOODFIELD
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:43008-0463
Mailing Address - Country:US
Mailing Address - Phone:614-902-0027
Mailing Address - Fax:
Practice Address - Street 1:701 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8592
Practice Address - Country:US
Practice Address - Phone:855-467-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician