Provider Demographics
NPI:1033975792
Name:TUTTLE, ANTIONETTE LEE
Entity Type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:LEE
Last Name:TUTTLE
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 1:901 MEM DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2475
Mailing Address - Country:US
Mailing Address - Phone:906-482-9400
Mailing Address - Fax:
Practice Address - Street 1:200 QUINCY ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1817
Practice Address - Country:US
Practice Address - Phone:906-482-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician