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Individual

THERESA ROUSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
640 CUTLIP RD, JACKSON, OH 45640-9451
(740) 710-2681
Mailing address
638 CUTLIP RD, JACKSON, OH 45640-9451
(740) 710-2681

Taxonomy

Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0164124
OH
01
4064686
OHIO DODD
OH
Enumeration date
10/27/2020
Last updated
10/27/2020
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