Provider Demographics
NPI:1376117911
Name:HOLCOMB, TAMI W (MSSA)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:W
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:W
Other - Last Name:HATHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSA
Mailing Address - Street 1:1085 LANDER RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3249
Mailing Address - Country:US
Mailing Address - Phone:440-668-1426
Mailing Address - Fax:
Practice Address - Street 1:2114 NOBLE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1725
Practice Address - Country:US
Practice Address - Phone:216-268-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator