Provider Demographics
NPI:1902587892
Name:KING, TRAVIS NEIL
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:NEIL
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6605 LONGSHORE STREET
Mailing Address - Street 2:SUITE 240, #185
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-363-0855
Mailing Address - Fax:614-363-0910
Practice Address - Street 1:6605 LONGSHORE STREET, SUITE 240
Practice Address - Street 2:#185
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-363-0855
Practice Address - Fax:614-363-0910
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRK610548343900000X, 347C00000X
372600000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion