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General NPI Number Information
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NPI Number | 1295405249
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Entity Type | Individual
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Provider Name | TAMIE LYNN GAETH
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Gender | Female
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 2762 PIGEON RD
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City | BAD AXE
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State | MI
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Zip | 48413-9738
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Country | US
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Telephone | 989-551-5204
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Fax | 989-269-0224
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Provider Business Mailing Address
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Address Line | 2762 PIGEON RD
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City | BAD AXE
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State | MI
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Zip | 48413-9738
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Country | US
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Telephone | 989-551-5204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 2883533
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License Number State | MI
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