MEDICARE: MRS. TAVITTA C KLINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	401139310810	OH

General Provider Information

NPI Number	:	1043619398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAVITTA C KLINE

Provider Business Mailing Address
First Line	:	5223 THOMAS ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1431
Country	:	US
Telephone Number	:	888-507-9816
Fax Number	:

Provider Business Practice Location Address
First Line	:	5223 THOMAS ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1431
Country	:	US
Telephone Number	:	888-507-9816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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