Healthcare Provider Details

I. General information

NPI: 1063134401
Provider Name (Legal Business Name): TABITHA MARIE KOHRING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LYNN RD STE 201
RAVENNA OH
44266-7838
US

IV. Provider business mailing address

538 BAKER DR NW
BOLIVAR OH
44612-8900
US

V. Phone/Fax

Practice location:
  • Phone: 216-264-0008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN.470083
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: