Individual
LINDA JO PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12097 HOLLY DR, LAKEVIEW, OH 43331-9275
(937) 210-0875
Mailing address
12105 HOLLY DR, LAKEVIEW, OH 43331-9275
(937) 210-0875
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
4601354
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0061345
—
OH
Enumeration date
12/07/2020
Last updated
12/07/2020
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