Provider Demographics
NPI:1457687998
Name:PRESTON, TABITHA J (LPN)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:J
Last Name:PRESTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-0167
Mailing Address - Country:US
Mailing Address - Phone:740-259-9636
Mailing Address - Fax:
Practice Address - Street 1:12327 STATE ROUTE 348
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8977
Practice Address - Country:US
Practice Address - Phone:740-259-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 128306164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse