Healthcare Provider Details

I. General information

NPI: 1982432431
Provider Name (Legal Business Name): TALEISHA MARIE SNIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 NEEDLE LANE
MONTANA MINES WV
26586
US

IV. Provider business mailing address

112 NEEDLE LANE
MONTANA MINES WV
26586
US

V. Phone/Fax

Practice location:
  • Phone: 304-694-6971
  • Fax:
Mailing address:
  • Phone: 304-694-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: