Provider Demographics
NPI:1700908746
Name:HEATH, CHELSEA MARIE
Entity Type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:MARIE
Last Name:HEATH
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 1:690 COUNTY ROAD 57 E
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9253
Mailing Address - Country:US
Mailing Address - Phone:937-592-0690
Mailing Address - Fax:
Practice Address - Street 1:690 COUNTY ROAD 57 E
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9253
Practice Address - Country:US
Practice Address - Phone:937-592-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2180054Medicaid