Provider Demographics
NPI:1144927997
Name:FERMON, TRINA
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:FERMON
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 1:3728 SUGARBARK DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7712
Mailing Address - Country:US
Mailing Address - Phone:248-412-3319
Mailing Address - Fax:
Practice Address - Street 1:3728 SUGARBARK DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7712
Practice Address - Country:US
Practice Address - Phone:248-412-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTR916778347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle