Healthcare Provider Details

I. General information

NPI: 1508597386
Provider Name (Legal Business Name): TABITHA MARIE FREEMANTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E WATERLOO RD
AKRON OH
44306-3805
US

IV. Provider business mailing address

1221 E WATERLOO RD
AKRON OH
44306-3805
US

V. Phone/Fax

Practice location:
  • Phone: 216-937-2800
  • Fax:
Mailing address:
  • Phone: 216-937-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2309019
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: