Provider Demographics
NPI:1861278293
Name:OPPER, TERESA A
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:OPPER
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 1:12647 STATE ROUTE 309
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-9475
Mailing Address - Country:US
Mailing Address - Phone:567-295-1130
Mailing Address - Fax:
Practice Address - Street 1:12647 STATE ROUTE 309
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-9475
Practice Address - Country:US
Practice Address - Phone:567-295-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTH519424374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide