Healthcare Provider Details

I. General information

NPI: 1306397641
Provider Name (Legal Business Name): TAMITRUIS MORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3732 BRIAR PL
DAYTON OH
45405-1802
US

IV. Provider business mailing address

3732 BRIAR PL
DAYTON OH
45405-1802
US

V. Phone/Fax

Practice location:
  • Phone: 937-751-6045
  • Fax:
Mailing address:
  • Phone: 937-751-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: