Provider Demographics
NPI:1144019357
Name:LAWRENCE, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:LAWRENCE
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 1:747 MILLER PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1052
Mailing Address - Country:US
Mailing Address - Phone:419-789-6064
Mailing Address - Fax:
Practice Address - Street 1:747 MILLER PARKWAY DR
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1052
Practice Address - Country:US
Practice Address - Phone:419-789-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker