Provider Demographics
NPI:1780350413
Name:MEDLEY, THIARA RENEE NICOLE
Entity type:Individual
Prefix:MS
First Name:THIARA
Middle Name:RENEE NICOLE
Last Name:MEDLEY
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 1:3532 COUNTRYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9783
Mailing Address - Country:US
Mailing Address - Phone:614-400-9065
Mailing Address - Fax:
Practice Address - Street 1:3532 COUNTRYVIEW DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9783
Practice Address - Country:US
Practice Address - Phone:614-400-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health