Provider Demographics
NPI:1417776824
Name:CRADDOCK, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:LEICHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BFA
Mailing Address - Street 1:311 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-1421
Mailing Address - Country:US
Mailing Address - Phone:419-707-0307
Mailing Address - Fax:
Practice Address - Street 1:311 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-1421
Practice Address - Country:US
Practice Address - Phone:419-707-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant