Provider Demographics
NPI:1639974546
Name:RODEN, ELISHA
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:RODEN
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 1:305 1/2 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:OH
Mailing Address - Zip Code:43543-1017
Mailing Address - Country:US
Mailing Address - Phone:419-630-8373
Mailing Address - Fax:
Practice Address - Street 1:305 1/2 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:OH
Practice Address - Zip Code:43543-1017
Practice Address - Country:US
Practice Address - Phone:419-630-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier