Provider Demographics
NPI:1245010248
Name:TRIMBLE, OKSANA NADEZDA
Entity type:Individual
Prefix:
First Name:OKSANA
Middle Name:NADEZDA
Last Name:TRIMBLE
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 1:661 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-1218
Mailing Address - Country:US
Mailing Address - Phone:724-640-3127
Mailing Address - Fax:
Practice Address - Street 1:56 ST. ADELBERT ST.
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44054
Practice Address - Country:US
Practice Address - Phone:440-568-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-23-68363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst