Individual
BRENDA KAY THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3860 US HIGHWAY 62 NE, WASHINGTON COURT HOUSE, OH 43160-9070
(740) 505-2279
Mailing address
3860 US HIGHWAY 62 NE, WASHINGTON COURT HOUSE, OH 43160-9070
(740) 505-2279
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
OH
3747P1801X
Personal Care Attendant
—
OH
376J00000X
Homemaker
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2819310
—
OH
Enumeration date
01/15/2021
Last updated
01/15/2021
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