Provider Demographics
NPI:1205523842
Name:CLAY, TIA JOAN
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:JOAN
Last Name:CLAY
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 1:3985 SENG CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25209-9020
Mailing Address - Country:US
Mailing Address - Phone:304-560-8794
Mailing Address - Fax:
Practice Address - Street 1:3985 SENG CREEK RD
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25209-9020
Practice Address - Country:US
Practice Address - Phone:304-560-8794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant