Provider Demographics
NPI:1336877794
Name:JONES, TANYA HAVILAND
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:HAVILAND
Last Name:JONES
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 1:33 SAMUEL CT
Mailing Address - Street 2:
Mailing Address - City:LAKE JUNALUSKA
Mailing Address - State:NC
Mailing Address - Zip Code:28745-8783
Mailing Address - Country:US
Mailing Address - Phone:828-246-8340
Mailing Address - Fax:
Practice Address - Street 1:33 SAMUEL CT
Practice Address - Street 2:
Practice Address - City:LAKE JUNALUSKA
Practice Address - State:NC
Practice Address - Zip Code:28745-8783
Practice Address - Country:US
Practice Address - Phone:828-246-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15261224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty