Provider Demographics
NPI:1932326220
Name:BARTLEY, LETITIA KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LETITIA
Middle Name:KAY
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E MAIN ST
Mailing Address - Street 2:LOT # 81
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-9079
Mailing Address - Country:US
Mailing Address - Phone:937-444-0363
Mailing Address - Fax:
Practice Address - Street 1:511 E MAIN ST
Practice Address - Street 2:LOT # 81
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-9079
Practice Address - Country:US
Practice Address - Phone:937-444-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 118528164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2645605Medicare UPIN