Provider Demographics
NPI:1336740737
Name:BRECKENRIDGE, CASHMEIRE CHAMPAIL
Entity type:Individual
Prefix:
First Name:CASHMEIRE
Middle Name:CHAMPAIL
Last Name:BRECKENRIDGE
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 1:7459 WILLOW LEAF DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7570
Mailing Address - Country:US
Mailing Address - Phone:614-816-4624
Mailing Address - Fax:
Practice Address - Street 1:7459 WILLOW LEAF DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7570
Practice Address - Country:US
Practice Address - Phone:614-816-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.173084.MEDS-IV164W00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No164W00000XNursing Service ProvidersLicensed Practical Nurse