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General NPI Number Information
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NPI Number | 1487097465
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Entity Type | Individual
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Provider Name | JESSICA LYNN TATTERSHALL D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 5480 NORQUEST BLVD
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City | AUSTINTOWN
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State | OH
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Zip | 44515-1820
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Country | US
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Telephone | 330-779-0529
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Fax | 330-797-0403
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Provider Business Mailing Address
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Address Line | 1 PERKINS SQ
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City | AKRON
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State | OH
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Zip | 44308-1063
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Country | US
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Telephone | 330-779-0529
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Fax | 330-797-0403
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 34.012084
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License Number State | OH
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