Provider Demographics
NPI:1144904848
Name:RODDY, TERRI KEEN
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:KEEN
Last Name:RODDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 S STATE ROUTE 100
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3638
Mailing Address - Country:US
Mailing Address - Phone:567-207-5949
Mailing Address - Fax:
Practice Address - Street 1:2056 S STATE ROUTE 100
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3638
Practice Address - Country:US
Practice Address - Phone:567-207-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver