Provider Demographics
NPI:1275397531
Name:BURTON, TYME
Entity Type:Individual
Prefix:
First Name:TYME
Middle Name:
Last Name:BURTON
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 1:4680 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-3243
Mailing Address - Country:US
Mailing Address - Phone:330-639-7468
Mailing Address - Fax:
Practice Address - Street 1:4680 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-3243
Practice Address - Country:US
Practice Address - Phone:330-639-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator