Provider Demographics
NPI:1306397641
Name:MORTON, TAMITRUIS
Entity Type:Individual
Prefix:
First Name:TAMITRUIS
Middle Name:
Last Name:MORTON
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 1:3732 BRIAR PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1802
Mailing Address - Country:US
Mailing Address - Phone:937-751-6045
Mailing Address - Fax:
Practice Address - Street 1:3732 BRIAR PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1802
Practice Address - Country:US
Practice Address - Phone:937-751-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171WH0202X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No171WH0202XOther Service ProvidersContractorHome Modifications