Provider Demographics
NPI:1003941212
Name:STUBBS, TARYN CAMILLE
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:CAMILLE
Last Name:STUBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17164 HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-6164
Mailing Address - Country:US
Mailing Address - Phone:540-663-2318
Mailing Address - Fax:
Practice Address - Street 1:17164 HAVEN CT
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-6164
Practice Address - Country:US
Practice Address - Phone:540-663-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12011009451744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management