Provider Demographics
NPI:1508698200
Name:DOOLEY, CLARISSA MARIE
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:MARIE
Last Name:DOOLEY
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 1:21225 SOUTH TECUMSEH ROAD
Mailing Address - Street 2:LOT 165
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502
Mailing Address - Country:US
Mailing Address - Phone:937-828-2919
Mailing Address - Fax:
Practice Address - Street 1:21225 SOUTH TECUMSEH ROAD
Practice Address - Street 2:LOT 165
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502
Practice Address - Country:US
Practice Address - Phone:937-828-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health