Provider Demographics
NPI:1972765030
Name:CLOSSON, CASEY
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:
Last Name:CLOSSON
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 1:501 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-1452
Mailing Address - Country:US
Mailing Address - Phone:440-892-9313
Mailing Address - Fax:
Practice Address - Street 1:501 OHIO ST
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-1452
Practice Address - Country:US
Practice Address - Phone:440-892-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2575708Medicaid