Healthcare Provider Details

I. General information

NPI: 1588980205
Provider Name (Legal Business Name): MRS. TASHA LASHAY OLTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 36TH ST SE
GRAND RAPIDS MI
49548-2319
US

IV. Provider business mailing address

PO BOX 141
GRAND RAPIDS MI
49501-0141
US

V. Phone/Fax

Practice location:
  • Phone: 616-726-1123
  • Fax: 616-243-2392
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: