Basic Information
| Provider Information | |||||||||
| NPI: | 1700379989 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HONSAKER | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | R. EPT., CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5106 SUMTER AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452383827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133787451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8118 CORPORATE WAY STE 212 | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450409560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139478433 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2018 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.