Janice Lee Fetherolf, AID
Individual provider Active NPI Home Health Aide · Millersport, OH
NPI 1104948843 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104948843
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Aide 374U00000X
- License
- 253359 (OH)
- Practice address
- 12209 Lecorne St
Millersport, OH 43046 - Phone
- (740) 507-8544
- NPI assigned
- Apr 4, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 253359 | OH | MD | Home Health Aide |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 253359 | OH | Yes |
Addresses
Primary practice location
12209 Lecorne St
Millersport, OH 43046
Mailing address
15231 St RT #93 South
Logan, OH 43138
Phone (740) 380-6210
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105552217999 | Medicaid | OH |
Other providers in Millersport, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.