Provider Demographics
NPI:1073986725
Name:MCCLAIN, TACCARA
Entity Type:Individual
Prefix:
First Name:TACCARA
Middle Name:
Last Name:MCCLAIN
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 1:28242 GREEN WILLOW
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331
Mailing Address - Country:US
Mailing Address - Phone:248-346-7486
Mailing Address - Fax:
Practice Address - Street 1:28242 GREEN WILLOW ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-2753
Practice Address - Country:US
Practice Address - Phone:248-346-7486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications