Healthcare Provider Details

I. General information

NPI: 1063836914
Provider Name (Legal Business Name): AMANDA TABELLION PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 WHIPPLE AVE NW
CANTON OH
44708-1534
US

IV. Provider business mailing address

7011 HAHN ST
LOUISVILLE OH
44641-8317
US

V. Phone/Fax

Practice location:
  • Phone: 330-477-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number010643
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: