Provider Demographics
NPI:1053191601
Name:HORTON, DONTE MICAH
Entity type:Individual
Prefix:
First Name:DONTE
Middle Name:MICAH
Last Name:HORTON
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 1:4325 OAKWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2643
Mailing Address - Country:US
Mailing Address - Phone:513-917-3730
Mailing Address - Fax:
Practice Address - Street 1:4325 OAKWOOD AVE APT 1
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:OH
Practice Address - Zip Code:45236-2643
Practice Address - Country:US
Practice Address - Phone:513-917-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care