Provider Demographics
NPI:1578118519
Name:PRESTON, TAMEACKO ANGELLIC
Entity Type:Individual
Prefix:MS
First Name:TAMEACKO
Middle Name:ANGELLIC
Last Name:PRESTON
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 1:1075 ELLSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5211
Mailing Address - Country:US
Mailing Address - Phone:330-093-1092
Mailing Address - Fax:
Practice Address - Street 1:1075 ELLSWORTH DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5211
Practice Address - Country:US
Practice Address - Phone:330-093-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications