Healthcare Provider Details

I. General information

NPI: 1619646023
Provider Name (Legal Business Name): TRANSFORMATIONS FOR LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4366 PEARSON PKWY
OREGON OH
43616-3572
US

IV. Provider business mailing address

4366 PEARSON PKWY
OREGON OH
43616-3572
US

V. Phone/Fax

Practice location:
  • Phone: 419-450-4771
  • Fax:
Mailing address:
  • Phone: 419-450-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE DANA BASSIOUNI
Title or Position: OWNER
Credential: PHYSICIAN ASSISTANT
Phone: 419-450-4771