Provider Demographics
NPI:1629821707
Name:CLINKSCALE, TIAWAN
Entity Type:Individual
Prefix:
First Name:TIAWAN
Middle Name:
Last Name:CLINKSCALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OMAR ST
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1553
Mailing Address - Country:US
Mailing Address - Phone:330-720-5326
Mailing Address - Fax:
Practice Address - Street 1:204 OMAR ST
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1553
Practice Address - Country:US
Practice Address - Phone:330-720-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide