Healthcare Provider Details

I. General information

NPI: 1891513198
Provider Name (Legal Business Name): TAMARA LYNN HURLBUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MARTINEL DR
KENT OH
44240-4380
US

IV. Provider business mailing address

222 PERRY ST
STRUTHERS OH
44471-2062
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-6339
  • Fax:
Mailing address:
  • Phone: 330-559-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: