Provider Demographics
NPI:1245861269
Name:ROBERTSON, TASHIA
Entity type:Individual
Prefix:
First Name:TASHIA
Middle Name:
Last Name:ROBERTSON
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 1:1115 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1311
Mailing Address - Country:US
Mailing Address - Phone:614-463-0799
Mailing Address - Fax:614-928-3035
Practice Address - Street 1:1115 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1311
Practice Address - Country:US
Practice Address - Phone:614-463-0799
Practice Address - Fax:614-928-3035
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1245861269Medicaid