Provider Demographics
NPI:1497470355
Name:TRAMBLE, PATICIA
Entity Type:Individual
Prefix:
First Name:PATICIA
Middle Name:
Last Name:TRAMBLE
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 1:3618 W MARKET ST STE 15
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2425
Mailing Address - Country:US
Mailing Address - Phone:234-466-0445
Mailing Address - Fax:
Practice Address - Street 1:3618 W MARKET ST STE 15
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2425
Practice Address - Country:US
Practice Address - Phone:234-466-0445
Practice Address - Fax:234-466-0359
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH880878351Medicaid