MEDICARE: ALYSSA TATUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP.12610	OH

General Provider Information

NPI Number	:	1285188284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA TATUM

Provider Business Mailing Address
First Line	:	1826 FAIRFAX AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207-1812
Country	:	US
Telephone Number	:	937-760-0289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1826 FAIRFAX AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45207
Country	:	US
Telephone Number	:	937-760-0289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	08/12/2018

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Directions to “ ALYSSA TATUM ” Practice Location

Language	Start Address	Practice Location

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