Healthcare Provider Details

I. General information

NPI: 1366163289
Provider Name (Legal Business Name): TYRITA RICHELLE MILLIGAN BS, CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W FRONT ST
PERRYSBURG OH
43551-1467
US

IV. Provider business mailing address

122 W FRONT ST
PERRYSBURG OH
43551-1467
US

V. Phone/Fax

Practice location:
  • Phone: 419-377-8417
  • Fax:
Mailing address:
  • Phone: 419-377-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: