Provider Demographics
NPI:1518659556
Name:WOODS, TYLA LYNETTE
Entity Type:Individual
Prefix:
First Name:TYLA
Middle Name:LYNETTE
Last Name:WOODS
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 1:3717 ELDERBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-2103
Mailing Address - Country:US
Mailing Address - Phone:937-800-6563
Mailing Address - Fax:
Practice Address - Street 1:3717 ELDERBERRY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-2103
Practice Address - Country:US
Practice Address - Phone:937-800-6563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3025130251E00000X
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health