Provider Demographics
NPI:1750156295
Name:EASLEY, DARRYL THOMAS
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:THOMAS
Last Name:EASLEY
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 1:1820 LITCHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3908
Mailing Address - Country:US
Mailing Address - Phone:937-718-0441
Mailing Address - Fax:
Practice Address - Street 1:1820 LITCHFIELD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3908
Practice Address - Country:US
Practice Address - Phone:937-718-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR640743343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)