Provider Demographics
NPI:1851661813
Name:SEYMOUR, TABATHA ANN (CERTIFIED NURSE TECH)
Entity Type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:ANN
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:CERTIFIED NURSE TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 S POHLMAN RD
Mailing Address - Street 2:APT. 4
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3762
Mailing Address - Country:US
Mailing Address - Phone:740-851-9639
Mailing Address - Fax:
Practice Address - Street 1:491 S POHLMAN RD
Practice Address - Street 2:APT. 4
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3762
Practice Address - Country:US
Practice Address - Phone:740-851-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCERT -2377-1967376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide