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Individual

MELISSA ANN BOOTH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
326 PATTON AVE, WINTERSVILLE, OH 43953-3848
(740) 317-7734
Mailing address
326 PATTON AVE, WINTERSVILLE, OH 43953-3848
(740) 317-7734

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
RT055489
OH
251S00000X
Community/Behavioral Health Agency
4101475
OH
251S00000X
Community/Behavioral Health Agency
Primary
DODD4101475
OH
251X00000X
Supports Brokerage Agency
DODD4101475
OH
253Z00000X
In Home Supportive Care Agency
DODD4101475
OH
3747P1801X
Personal Care Attendant
DODD4101475
OH
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
DODD4101475
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0058808
OH
Enumeration date
11/30/2020
Last updated
10/20/2022
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