Healthcare Provider Details

I. General information

NPI: 1720904717
Provider Name (Legal Business Name): TABITHA L BIVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 NECCO AVE
DAYTON OH
45406-3557
US

IV. Provider business mailing address

3915 NECCO AVE
DAYTON OH
45406-3557
US

V. Phone/Fax

Practice location:
  • Phone: 326-209-2691
  • Fax:
Mailing address:
  • Phone: 326-209-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number5718967
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: