MEDICARE: TAMITRUIS MORTON

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	171WH0202X	Home Modifications Contractor		OH
2	347C00000X	Private Vehicle		OH

General Provider Information

NPI Number	:	1306397641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMITRUIS MORTON

Provider Business Mailing Address
First Line	:	3732 BRIAR PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1802
Country	:	US
Telephone Number	:	937-751-6045
Fax Number	:

Provider Business Practice Location Address
First Line	:	3732 BRIAR PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1802
Country	:	US
Telephone Number	:	937-751-6045
Fax Number	:

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

Provider Enumeration Date	:	10/21/2016
Last Update Date	:	10/21/2016

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Directions to “ TAMITRUIS MORTON ” Practice Location

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