Individual
REVA SABRINA LYTTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4607 KENTFIELD DR, DAYTON, OH 45426-1853
(937) 837-2558
Mailing address
4607 KENTFIELD DR, TROTWOOD, OH 45426-1853
(937) 837-2558
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1221TB
—
OH
Enumeration date
02/22/2012
Last updated
02/22/2012
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