=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871248161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. TAMMY WARD-CHAPPELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2022
-----------------------------------------------------
Last Update Date | 02/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10735 RAVENNA RD STE 206
-----------------------------------------------------
City | TWINSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44087-3107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-551-2249
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26090 BROADWAY AVE
-----------------------------------------------------
City | OAKWOOD VILLAGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44146-6520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------