Provider Demographics
NPI:1265240675
Name:REID, DE'AIRRA DIANE
Entity type:Individual
Prefix:
First Name:DE'AIRRA
Middle Name:DIANE
Last Name:REID
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 1:4497 BUFORT BLVD
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5582
Mailing Address - Country:US
Mailing Address - Phone:937-877-9171
Mailing Address - Fax:
Practice Address - Street 1:4497 BUFORT BLVD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-5582
Practice Address - Country:US
Practice Address - Phone:937-877-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVM177340172A00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No172A00000XOther Service ProvidersDriverGroup - Single Specialty