Provider Demographics
NPI:1396534350
Name:PORTIS, TASHA EAUR
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:EAUR
Last Name:PORTIS
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 1:5850 REAMS DR S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3651
Mailing Address - Country:US
Mailing Address - Phone:251-767-6215
Mailing Address - Fax:251-767-6215
Practice Address - Street 1:3439 DIAL ST
Practice Address - Street 2:
Practice Address - City:WHISTLER
Practice Address - State:AL
Practice Address - Zip Code:36612-1629
Practice Address - Country:US
Practice Address - Phone:251-767-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services