Provider Demographics
NPI:1396624441
Name:GOOD, REX A
Entity type:Individual
Prefix:
First Name:REX
Middle Name:A
Last Name:GOOD
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 1:15397 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:OH
Mailing Address - Zip Code:43543-9608
Mailing Address - Country:US
Mailing Address - Phone:419-553-9983
Mailing Address - Fax:
Practice Address - Street 1:15397 COUNTY ROAD J
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:OH
Practice Address - Zip Code:43543-9608
Practice Address - Country:US
Practice Address - Phone:419-553-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRU4797613747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant