Provider Demographics
NPI:1730677519
Name:GAITER, CLARISSA ANTOINETTE
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:ANTOINETTE
Last Name:GAITER
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 1:872 DAVIES AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2706
Mailing Address - Country:US
Mailing Address - Phone:330-310-3773
Mailing Address - Fax:
Practice Address - Street 1:1041 ROMIG AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-1343
Practice Address - Country:US
Practice Address - Phone:330-310-3773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health