Provider Demographics
NPI:1346625621
Name:CLAYBROOK, TIA
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:CLAYBROOK
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 1:1506 ZAIGER PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-2248
Mailing Address - Country:US
Mailing Address - Phone:719-287-2902
Mailing Address - Fax:719-265-1752
Practice Address - Street 1:1506 ZAIGER PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-2248
Practice Address - Country:US
Practice Address - Phone:719-287-2902
Practice Address - Fax:719-265-1752
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0008471171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor