Provider Demographics
NPI:1083312524
Name:DODDS, TARINA
Entity Type:Individual
Prefix:
First Name:TARINA
Middle Name:
Last Name:DODDS
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 1:4736 W SCRANTON PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2959
Mailing Address - Country:US
Mailing Address - Phone:414-303-5787
Mailing Address - Fax:
Practice Address - Street 1:4736 W SCRANTON PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2959
Practice Address - Country:US
Practice Address - Phone:414-303-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care