Healthcare Provider Details

I. General information

NPI: 1821152216
Provider Name (Legal Business Name): MRS. TAMMY MARION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 CHESTER GROOMS RD
WEST UNION OH
45693-9560
US

IV. Provider business mailing address

69 CHESTER GROOMS RD
WEST UNION OH
45693
US

V. Phone/Fax

Practice location:
  • Phone: 937-544-8525
  • Fax:
Mailing address:
  • Phone: 937-544-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: