Individual
ETHAN THOMAS ROY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3590 US HIGHWAY 23, CHILLICOTHE, OH 45601-8341
(740) 663-7386
Mailing address
727 1/2 E MAIN ST, CHILLICOTHE, OH 45601-3506
(937) 403-6773
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0098268
—
OH
Enumeration date
12/30/2020
Last updated
12/30/2020
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