MEDICARE: MS. TATIANA MONET PUTNAM

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	374U00000X	Home Health Aide	UD302796	OH

General Provider Information

NPI Number	:	1396522330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TATIANA MONET PUTNAM

Provider Business Mailing Address
First Line	:	901 PACKARD DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2817
Country	:	US
Telephone Number	:	330-741-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 PACKARD DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2817
Country	:	US
Telephone Number	:	330-741-0026
Fax Number	:

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

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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