Individual
TERA CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
159 DORTMUND DR, FAYETTEVILLE, OH 45118-9406
(513) 283-4435
Mailing address
159 DORTMUND DR, FAYETTEVILLE, OH 45118-9406
(513) 283-4435
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0801623
—
OH
Enumeration date
10/14/2020
Last updated
10/14/2020
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