Provider Demographics
NPI:1588429336
Name:TALBOTT, CONNIE S
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:TALBOTT
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 1:150 W CHURCH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-9229
Mailing Address - Country:US
Mailing Address - Phone:740-275-6097
Mailing Address - Fax:
Practice Address - Street 1:150 W CHURCH ST APT 4
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-9229
Practice Address - Country:US
Practice Address - Phone:740-275-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home