Basic Information
| Provider Information | |||||||||
| NPI: | 1912338567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | PERRY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4936 SOLAR DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432141726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143154075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1652 OLD HENDERSON RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432203618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144596901 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2013 | ||||||||
| LastUpdateDate: | 12/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | OTA-05342 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.