MEDICARE: TABITHA ROBERSON

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1679162903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA ROBERSON

Provider Business Mailing Address
First Line	:	2352 KENNARD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-1153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2352 KENNARD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-1153
Country	:	US
Telephone Number	:	216-361-1990
Fax Number	:

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

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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Directions to “ TABITHA ROBERSON ” Practice Location

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