Provider Demographics
NPI:1659156628
Name:TANTOH, MATILDA NDUM
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:NDUM
Last Name:TANTOH
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 1:5567 PINE NEEDLE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1842
Mailing Address - Country:US
Mailing Address - Phone:513-344-7213
Mailing Address - Fax:
Practice Address - Street 1:5567 PINE NEEDLE CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1842
Practice Address - Country:US
Practice Address - Phone:513-344-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services