Provider Demographics
NPI:1477449924
Name:HODGE, TABATHA ANNE
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:ANNE
Last Name:HODGE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 BLEDSOE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SALT ROCK
Mailing Address - State:WV
Mailing Address - Zip Code:25559-1411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:462 BLEDSOE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SALT ROCK
Practice Address - State:WV
Practice Address - Zip Code:25559-1411
Practice Address - Country:US
Practice Address - Phone:304-634-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide