1992920425 NPI number — MRS. SHEILA MARIE GILLESPIE PTA

Table of content: MRS. SHEILA MARIE GILLESPIE PTA (NPI 1992920425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992920425 NPI number — MRS. SHEILA MARIE GILLESPIE PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLESPIE
Provider First Name:
SHEILA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
SHEILA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992920425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9954 LOOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLERSPORT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43046-9604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-964-1442
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3580 DISCOVERY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43123-9329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-293-1068
Provider Business Practice Location Address Fax Number:
614-293-7729
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  4213 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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