Provider Demographics
NPI:1184273419
Name:PELLETT, THOMAS R (RN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:PELLETT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 HEBRON RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1045
Mailing Address - Country:US
Mailing Address - Phone:740-504-0682
Mailing Address - Fax:
Practice Address - Street 1:2128 HEBRON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1045
Practice Address - Country:US
Practice Address - Phone:740-504-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.455734163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNO OTHER PROVIDER NUMBERD