Provider Demographics
NPI:1013459445
Name:CAPEL, TIA
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:CAPEL
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:PO BOX 4664
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4664
Mailing Address - Country:US
Mailing Address - Phone:910-975-4280
Mailing Address - Fax:
Practice Address - Street 1:636 DIXON AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5352
Practice Address - Country:US
Practice Address - Phone:910-975-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013459445Medicaid
NC1013459445Medicaid