Provider Demographics
NPI:1164295457
Name:SEEBACH, MARY TABITHA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TABITHA
Last Name:SEEBACH
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 1:2213 TYTUS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2354
Mailing Address - Country:US
Mailing Address - Phone:513-292-5084
Mailing Address - Fax:
Practice Address - Street 1:2213 TYTUS AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2354
Practice Address - Country:US
Practice Address - Phone:513-292-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003408175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist