Individual
JEFFREY DERTHICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6470 STREETER RD, MANTUA, OH 44255-9729
(330) 221-1046
Mailing address
6470 STREETER RD, MANTUA, OH 44255-9729
(330) 221-1046
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
OH
Other
Enumeration date
03/08/2025
Last updated
03/08/2025
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