Provider Demographics
NPI:1013654540
Name:GROVE, TAMBRALLINA (MED)
Entity Type:Individual
Prefix:
First Name:TAMBRALLINA
Middle Name:
Last Name:GROVE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 US HIGHWAY 42 NE
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9597
Mailing Address - Country:US
Mailing Address - Phone:614-753-5181
Mailing Address - Fax:
Practice Address - Street 1:4664 LARWELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3621
Practice Address - Country:US
Practice Address - Phone:614-487-7805
Practice Address - Fax:614-487-7809
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician