Healthcare Provider Details

I. General information

NPI: 1285543819
Provider Name (Legal Business Name): TATYANA RUDOLFOVNA MIROCHNITCHENKO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TATYANA RUDOLFOVNA SHERMAN LMT

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 DUSTIN RD
OREGON OH
43616-4342
US

IV. Provider business mailing address

923 MAMBRINO RD
OREGON OH
43616-3140
US

V. Phone/Fax

Practice location:
  • Phone: 419-344-1946
  • Fax:
Mailing address:
  • Phone: 419-344-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.026651
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: