Provider Demographics
NPI:1659106060
Name:SAVAGE, BLOSSOM
Entity type:Individual
Prefix:
First Name:BLOSSOM
Middle Name:
Last Name:SAVAGE
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 1:14996 PLEASANT VALLEY RD LOT 17
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-4075
Mailing Address - Country:US
Mailing Address - Phone:740-970-0601
Mailing Address - Fax:
Practice Address - Street 1:200 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1245
Practice Address - Country:US
Practice Address - Phone:740-970-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant