Provider Demographics
NPI:1912542283
Name:EBLIN, CASEY ELLEN
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ELLEN
Last Name:EBLIN
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 1:209 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROVER HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45849-9530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVER HILL
Practice Address - State:OH
Practice Address - Zip Code:45849-9530
Practice Address - Country:US
Practice Address - Phone:419-439-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health