Provider Demographics
NPI:1861102493
Name:CANTRELL, BOBBI JEAN
Entity type:Individual
Prefix:MS
First Name:BOBBI
Middle Name:JEAN
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BOBBI
Other - Middle Name:JEAN
Other - Last Name:GERLAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6305 HEFFNER RD.
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371
Mailing Address - Country:US
Mailing Address - Phone:937-732-2618
Mailing Address - Fax:
Practice Address - Street 1:6305 HEFFNER RD
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371
Practice Address - Country:US
Practice Address - Phone:937-732-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities