MEDICARE: TABITHA DORNAL

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1275245508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA DORNAL

Provider Business Mailing Address
First Line	:	3457 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1332
Country	:	US
Telephone Number	:	513-282-5591
Fax Number	:	513-954-4670

Provider Business Practice Location Address
First Line	:	3457 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1332
Country	:	US
Telephone Number	:	513-282-5591
Fax Number	:	513-954-4670

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

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	12/19/2022

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Directions to “ TABITHA DORNAL ” Practice Location

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