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Individual

MODESTA DOUGLAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
208 E SOUTH WATER ST, LEWISBURG, OH 45338-8093
(937) 361-2178
Mailing address
PO BOX 75, LEWISBURG, OH 45338-0075
(937) 757-5667

Taxonomy

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

Other

Enumeration date
09/21/2023
Last updated
12/18/2025
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