Provider Demographics
NPI:1184479453
Name:MADDUX, THERESA DIANE
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:DIANE
Last Name:MADDUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:DIANE
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1936 SUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-3233
Mailing Address - Country:US
Mailing Address - Phone:863-409-9720
Mailing Address - Fax:
Practice Address - Street 1:1936 SUMAN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-3233
Practice Address - Country:US
Practice Address - Phone:863-409-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services