Provider Demographics
NPI:1053913897
Name:CALDWELL, TERESA DIANN
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DIANN
Last Name:CALDWELL
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 1:1838 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45148-9704
Mailing Address - Country:US
Mailing Address - Phone:937-725-2117
Mailing Address - Fax:
Practice Address - Street 1:1838 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:OH
Practice Address - Zip Code:45148-9704
Practice Address - Country:US
Practice Address - Phone:937-725-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care