Provider Demographics
NPI:1356950257
Name:TERRELL, COREY
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:TERRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 TWO MILE RUN RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER
Mailing Address - State:OH
Mailing Address - Zip Code:45724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2264 TWO MILE RUN RD
Practice Address - Street 2:
Practice Address - City:CUTLER
Practice Address - State:OH
Practice Address - Zip Code:45724-5228
Practice Address - Country:US
Practice Address - Phone:740-336-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant