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General NPI Number Information
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NPI Number | 1619646023
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIONS FOR LIFE
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 4366 PEARSON PKWY
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City | OREGON
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State | OH
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Zip | 43616-3572
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Country | US
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Telephone | 419-450-4771
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Fax |
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Provider Business Mailing Address
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Address Line | 4366 PEARSON PKWY
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City | OREGON
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State | OH
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Zip | 43616-3572
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Country | US
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Telephone | 419-450-4771
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE DANA BASSIOUNI
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Credential | PHYSICIAN ASSISTANT
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Telephone | 419-450-4771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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