Individual
TEENA MARIE GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1035 COUNTY ROAD 1 APT.215, SOUTH POINT, OH 45680-7382
(740) 302-7354
Mailing address
2657 COUNTY ROAD 18, SOUTH POINT, OH 45680-7382
(740) 302-7354
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
RP582668
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1022401
CHOICES
OH
05
—
1022Q401
—
OH
Enumeration date
04/13/2021
Last updated
04/13/2021
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